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Abstract：
BACKGROUND: Accurate prenatal recognition of discordant fetal growth in twins is critical for deciding suitable management strategies. We explored the predictive value of the level of maternal second-trimester placental growth factor (PLGF) as a novel indicator of discordant fetal growth.
METHODS: A total of 860 women pregnant with twins were enrolled, including 168 women with monochorionic twins (31 cases of discordant fetal growth and 137 without) and 692 with dichorionic twins (79 cases of discordant fetal growth and 613 without). Maternal second-trimester PLGF concentrations were measured via immunofluorescence.
RESULTS: Maternal second-trimester PLGF levels were significantly lower in women pregnant with twins who subsequently developed discordant fetal growth than in those who did not (monochorionic twin pregnancy: P < 0.001; dichorionic twin pregnancy: P < 0.001). A 3-4 fold difference in median PLGF concentrations was detected between the two groups with both monochorionic and dichorionic twin pregnancies. Maternal second-trimester PLGF levels were significantly correlated with birth weight differences (monochorionic twin pregnancy: r = - 0.331, P < 0.001; dichorionic twin pregnancy: r = - 0.234, P < 0.001). A receiver operating characteristic curve was used to evaluate the predictive efficiency. In monochorionic twin pregnancies, the area under the curve (AUC) was 0.751 (95% confidence interval [CI]: 0.649-0.852), and the cutoff value was 187.5 pg/mL with a sensitivity of 77.4% and specificity of 71.0%. In dichorionic twin pregnancies, the AUC was 0.716 (95% CI; 0.655-0.777), and the cutoff value was 252.5 pg/mL with a sensitivity of 65.1% and specificity of 69.6%. Based on the above cutoff values, univariate and multivariate logistic regression analyses were performed to calculate the odds ratios (OR) for the PLGF levels. After adjustment for potential confounding factors, low PLGF concentrations still significantly increased the risk of discordant fetal growth (monochorionic twin pregnancy: adjusted OR: 7.039, 95% CI: 2.798-17.710, P < 0.001; dichorionic twin pregnancy: adjusted OR: 4.279, 95% CI: 2.572-7.120, P < 0.001).
CONCLUSIONS: A low maternal second-trimester PLGF level is considered a remarkable risk factor and potential predictor of discordant fetal growth. This finding provides a complementary screening strategy for the prediction of discordant fetal growth and offers a unique perspective for the subsequent research in this field.
METHODS: A total of 860 women pregnant with twins were enrolled, including 168 women with monochorionic twins (31 cases of discordant fetal growth and 137 without) and 692 with dichorionic twins (79 cases of discordant fetal growth and 613 without). Maternal second-trimester PLGF concentrations were measured via immunofluorescence.
RESULTS: Maternal second-trimester PLGF levels were significantly lower in women pregnant with twins who subsequently developed discordant fetal growth than in those who did not (monochorionic twin pregnancy: P < 0.001; dichorionic twin pregnancy: P < 0.001). A 3-4 fold difference in median PLGF concentrations was detected between the two groups with both monochorionic and dichorionic twin pregnancies. Maternal second-trimester PLGF levels were significantly correlated with birth weight differences (monochorionic twin pregnancy: r = - 0.331, P < 0.001; dichorionic twin pregnancy: r = - 0.234, P < 0.001). A receiver operating characteristic curve was used to evaluate the predictive efficiency. In monochorionic twin pregnancies, the area under the curve (AUC) was 0.751 (95% confidence interval [CI]: 0.649-0.852), and the cutoff value was 187.5 pg/mL with a sensitivity of 77.4% and specificity of 71.0%. In dichorionic twin pregnancies, the AUC was 0.716 (95% CI; 0.655-0.777), and the cutoff value was 252.5 pg/mL with a sensitivity of 65.1% and specificity of 69.6%. Based on the above cutoff values, univariate and multivariate logistic regression analyses were performed to calculate the odds ratios (OR) for the PLGF levels. After adjustment for potential confounding factors, low PLGF concentrations still significantly increased the risk of discordant fetal growth (monochorionic twin pregnancy: adjusted OR: 7.039, 95% CI: 2.798-17.710, P < 0.001; dichorionic twin pregnancy: adjusted OR: 4.279, 95% CI: 2.572-7.120, P < 0.001).
CONCLUSIONS: A low maternal second-trimester PLGF level is considered a remarkable risk factor and potential predictor of discordant fetal growth. This finding provides a complementary screening strategy for the prediction of discordant fetal growth and offers a unique perspective for the subsequent research in this field.
摘要：
背景：准确的产前识别双生子中不一致的胎儿生长对于决定合适的管理策略至关重要。我们探讨了孕妇孕中期胎盘生长因子（PLGF）水平作为胎儿生长不一致的新指标的预测价值。
方法：共纳入860名双胞胎孕妇，其中单绒毛膜双生子168例(胎儿生长不一致31例,无胎儿137例)和双绒毛膜双生子692例(胎儿生长不一致79例,无胎儿613例)。通过免疫荧光测量母体孕中期的PLGF浓度。
结果：孕妇妊娠中期的PLGF水平在随后发生不一致胎儿生长的双胞胎孕妇中明显低于未发生妊娠的孕妇（单绒毛膜双胎妊娠：P<0.001；双绒毛膜双胎妊娠：P<0.001）。在单绒毛膜和双绒毛膜双胎妊娠的两组之间检测到PLGF的中位数浓度差异为3-4倍。孕妇孕中期PLGF水平与出生体重差异显着相关（单胎双胎妊娠：r=-0.331，P<0.001；双胎妊娠：r=-0.234，P<0.001）。使用接收器工作特性曲线来评估预测效率。在单绒毛膜双胎妊娠中，曲线下面积（AUC）为0.751（95％置信区间[CI]：0.649-0.852），截断值为187.5pg/mL,敏感性为77.4%,特异性为71.0%。在双胎双胎妊娠中，AUC为0.716（95%CI；0.655-0.777），截断值为252.5pg/mL，敏感性为65.1%，特异性为69.6%。根据上述截止值，我们进行了单变量和多变量逻辑回归分析,以计算PLGF水平的比值比(OR).在调整了潜在的混杂因素后，低PLGF浓度仍然显著增加胎儿生长不一致的风险(单绒毛膜双胎妊娠:调整OR:7.039,95%CI:2.798-17.710,P<0.001;双绒毛膜双胎妊娠:调整OR:4.279,95%CI:2.572-7.120,P<0.001).
结论：孕妇孕中期PLGF水平低被认为是胎儿生长不协调的显著危险因素和潜在预测因素。这一发现为预测不一致的胎儿生长提供了补充的筛查策略，并为该领域的后续研究提供了独特的视角。
方法：共纳入860名双胞胎孕妇，其中单绒毛膜双生子168例(胎儿生长不一致31例,无胎儿137例)和双绒毛膜双生子692例(胎儿生长不一致79例,无胎儿613例)。通过免疫荧光测量母体孕中期的PLGF浓度。
结果：孕妇妊娠中期的PLGF水平在随后发生不一致胎儿生长的双胞胎孕妇中明显低于未发生妊娠的孕妇（单绒毛膜双胎妊娠：P<0.001；双绒毛膜双胎妊娠：P<0.001）。在单绒毛膜和双绒毛膜双胎妊娠的两组之间检测到PLGF的中位数浓度差异为3-4倍。孕妇孕中期PLGF水平与出生体重差异显着相关（单胎双胎妊娠：r=-0.331，P<0.001；双胎妊娠：r=-0.234，P<0.001）。使用接收器工作特性曲线来评估预测效率。在单绒毛膜双胎妊娠中，曲线下面积（AUC）为0.751（95％置信区间[CI]：0.649-0.852），截断值为187.5pg/mL,敏感性为77.4%,特异性为71.0%。在双胎双胎妊娠中，AUC为0.716（95%CI；0.655-0.777），截断值为252.5pg/mL，敏感性为65.1%，特异性为69.6%。根据上述截止值，我们进行了单变量和多变量逻辑回归分析,以计算PLGF水平的比值比(OR).在调整了潜在的混杂因素后，低PLGF浓度仍然显著增加胎儿生长不一致的风险(单绒毛膜双胎妊娠:调整OR:7.039,95%CI:2.798-17.710,P<0.001;双绒毛膜双胎妊娠:调整OR:4.279,95%CI:2.572-7.120,P<0.001).
结论：孕妇孕中期PLGF水平低被认为是胎儿生长不协调的显著危险因素和潜在预测因素。这一发现为预测不一致的胎儿生长提供了补充的筛查策略，并为该领域的后续研究提供了独特的视角。
