Trajectories of Maternal Placental Growth Factor Levels from Early to Late Pregnancy: Prenatal Factors and Adverse Perinatal Outcomes.

Background: Knowledge on longitudinal trajectories of maternal placental growth factor (PlGF) levels, their prenatal factors, and their associations with adverse perinatal outcomes is lacking. We sought to identify PlGF trajectories, examine associations of prenatal factors with these trajectories, and determine whether these trajectories are associated with adverse perinatal outcomes. Methods: This retrospective cohort study included 438 pregnant women with multiple PlGF measurements. Group-based trajectory modeling identified distinct PlGF trajectories. Logistic and linear regression examined associations of trajectories with prenatal factors and adverse perinatal outcomes. Results: Three PlGF trajectories were identified. The high (46.6%) and moderate (40.6%) PlGF level trajectories tracked together until the late second trimester, after which the moderate trajectory plateaued and then declined steeply in the third trimester while the high trajectory remained elevated, peaking in the early third trimester before declining gradually. The low PlGF level trajectory (12.8%) maintained the lowest overall levels, rising modestly to an early peak before declining progressively. Uterine fibroids were associated with higher odds of the moderate and low trajectories, as was a history of late adverse obstetric outcomes. Conversely, a history of early pregnancy loss was associated with reduced odds of these trajectories. Additionally, each 1 kg/m Conclusion: Maternal PlGF trajectories are shaped by prenatal factors. Both moderate and low trajectories markedly increase the odds of adverse perinatal outcomes, underscoring the potential value of dynamic PlGF monitoring for early risk stratification and identification of high-risk pregnancies.