{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T18:37:06Z","timestamp":1791311826941,"version":"4.3.1"},"reference-count":34,"publisher":"American Medical Association (AMA)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Early preterm birth (ie, at less than 34 weeks\u2019 gestation) confers a high risk for adverse health outcomes, yet no universal screening strategy exists, preventing targeted delivery of effective interventions.<\/jats:p><\/jats:sec>Objective<\/jats:title>To evaluate the ability of midpregnancy placental growth factor (PlGF) screening to identify pregnancies at highest risk for early preterm birth.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This prospective cohort study was conducted at an urban, tertiary care center from 2020 to 2023. Participants were unselected, pregnant people with singleton pregnancies, receiving universal-access prenatal care from obstetricians, family physicians, or midwives, who underwent a PlGF test at the time of routine gestational diabetes screening, typically at 24 to 28 weeks\u2019 gestation. Data were analyzed from January to May 2024.<\/jats:p><\/jats:sec>Exposure<\/jats:title>PlGF level less than 100 pg\/mL at the time of gestational diabetes screen.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary outcome was all early preterm birth, defined as less than 34 weeks\u2019 gestation. Secondary outcomes included iatrogenic preterm birth, spontaneous preterm birth, preeclampsia, stillbirth, and small-for-gestational-age birth weight.<\/jats:p><\/jats:sec>Results<\/jats:title>Among 9037 unique pregnant individuals, 156 (1.7%) experienced early preterm birth (52 spontaneous births; 104 iatrogenic births). The area under the curve (AUC) for PlGF and early preterm birth was 0.80 (95% CI, 0.75-0.85). Low PlGF level was associated with early preterm birth (positive likelihood ratio [LR], 79.400 [95% CI, 53.434-115.137]; negative LR, 0.606 [95% CI, 0.494-0.742]; specificity, 99.5% [95% CI, 99.3%-99.6%]; negative predictive value, 98.9% [95% CI, 98.8%-99.1%]). Time to birth from PlGF test was significantly reduced among patients with a PlGF level less than 100 pg\/mL, among whom more than 50% delivered within 50 days of testing. Individuals with a low PlGF level made up more than 30% of subsequent stillbirths (aRR, 36.78 [95% CI, 18.63-72.60]) and more than half of patients requiring iatrogenic early preterm birth (aRR, 92.11 [95% CI, 64.83-130.87]). The AUC for iatrogenic early preterm birth was 0.90 (95% CI, 0.85-0.94).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>These findings suggest that low PlGF level (&amp;lt;100 pg\/mL), identified at the time of routine gestational diabetes screening, may be a powerful clinical tool to identify pregnant people at risk of early preterm birth, especially in iatrogenic births. Strategic redirection of tertiary health care resources to this high-risk group could improve maternal and perinatal outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.44454","type":"journal-article","created":{"date-parts":[[2024,11,14]],"date-time":"2024-11-14T16:00:47Z","timestamp":1731600047000},"page":"e2444454","source":"Crossref","is-referenced-by-count":33,"title":["Midpregnancy Placental Growth Factor Screening and Early Preterm Birth"],"prefix":"10.1001","volume":"7","author":[{"given":"Rachel A.","family":"Gladstone","sequence":"first","affiliation":[{"name":"Departments of Obstetrics & Gynecology, Maternal-Fetal Medicine Division, University of Toronto, Toronto, Ontario, Canada"},{"name":"Department of Obstetrics & Gynecology, University of Toronto, Toronto, Ontario, Canada"},{"name":"Institute of Health Policy, Management, and Evaluation, University of Toronto, Ontario, 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