{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T06:53:12Z","timestamp":1791269592714,"version":"4.1.0"},"reference-count":25,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology & Obste"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Preterm birth (PTB) is a leading cause of global neonatal mortality and long\u2010term complications. Placental growth factor (PlGF) is a key regulator of placental vascular development; however, prospective evidence regarding the association between its first\u2010trimester levels and the risk of PTB remains insufficient. This study aimed to investigate the association between first\u2010trimester PlGF levels and PTB, including its subtypes.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This was a single\u2010center prospective cohort study. From August 2023 to October 2025, a total of 1448 women with singleton pregnancies at 11\u201313\u2009+\u20096\u2009weeks of gestation were enrolled at Peking University International Hospital. Peripheral blood was collected during the first trimester for the measurement of PlGF concentration. Raw PlGF concentrations (pg\/mL) were converted to multiples of the median (MoM) using the Fetal Medicine Foundation online calculator. The primary outcome was PTB, defined as delivery between 28 and\u2009<\u200937\u2009weeks of gestation. The association between PlGF and PTB was assessed using multivariable log\u2010binomial regression, restricted cubic splines, and Cox proportional hazards models.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among the 1448 participants, 80 (5.5%) experienced PTB. Lower first\u2010trimester PlGF\u2010MoM was associated with an increased risk of PTB after adjustment for maternal characteristics (adjusted risk ratio\u2009=\u20090.303, 95% confidence interval: 0.14\u20130.61). Restricted cubic spline analysis demonstrated a significant nonlinear association (\n p<\/jats:italic>\n for nonlinearity <0.001), with higher PTB risk observed primarily among women with lower PlGF\u2013MoM levels. Time\u2010to\u2010event analysis further showed that higher PlGF\u2013MoM was associated with a lower cumulative incidence of PTB (adjusted hazard ratio\u2009=\u20090.56, 95% CI: 0.35\u20130.88). Incorporating PlGF\u2013MoM into a clinical prediction model modestly improved discrimination (area under the curve from 0.590 to 0.684,\n P<\/jats:italic>\n \u2009=\u20090.01), although predictive performance remained limited.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Lower first\u2010trimester PlGF\u2013MoM was associated with an increased risk of PTB in this prospective cohort, showing a nonlinear exposure\u2013response pattern. First\u2010trimester PlGF might provide additional information for early identification of women at higher risk of PTB; however, its clinical utility requires validation in larger and diverse populations.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/ijgo.71370","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T06:35:08Z","timestamp":1791268508000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association between first\u2010trimester placental growth factor and preterm birth: A prospective cohort study"],"prefix":"10.1002","author":[{"given":"Xue","family":"Zhao","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Peking University International Hospital Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiangtao","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Peking University International Hospital Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Peng","sequence":"additional","affiliation":[{"name":"National Research Institute for Family Planning Beijing China"},{"name":"Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhi","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Peking University International Hospital Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiaoya","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Peking University International Hospital Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanyuan","family":"Wang","sequence":"additional","affiliation":[{"name":"National Research Institute for Family Planning Beijing China"},{"name":"National Human Genetic Resources Center Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Peking University International Hospital Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1074-4279","authenticated-orcid":false,"given":"Jing","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Beijing Jishuitan Hospital, Capital Medical University Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,5]]},"reference":[{"issue":"4","key":"e_1_2_12_2_1","first-page":"257","article-title":"Clinical guidelines for the prevention and treatment of preterm birth (2024 edition)","volume":"59","author":"Chinese Medical Association","year":"2024","journal-title":"Chin J 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from a Canadian tertiary maternity referral center","volume":"77","author":"McLaughlin K","year":"2021","journal-title":"Hypertension"},{"issue":"10183","key":"e_1_2_12_7_1","doi-asserted-by":"crossref","first-page":"1807","DOI":"10.1016\/S0140-6736(18)33212-4","article-title":"Placental growth factor testing to assess women with suspected pre\u2010eclampsia: a multicentre, pragmatic, stepped\u2010wedge cluster\u2010randomised controlled trial","volume":"393","author":"Duhig KE","year":"2019","journal-title":"Lancet"},{"issue":"19","key":"e_1_2_12_8_1","doi-asserted-by":"crossref","first-page":"2121","DOI":"10.1161\/CIRCULATIONAHA.113.003215","article-title":"Diagnostic accuracy of placental growth factor in women with suspected preeclampsia: a prospective multicenter study","volume":"128","author":"Chappell LC","year":"2013","journal-title":"Circulation"},{"issue":"1","key":"e_1_2_12_9_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1002\/ijgo.12802","article-title":"The International Federation of Gynecology and Obstetrics (FIGO) initiative on pre\u2010eclampsia: a pragmatic guide for first\u2010trimester screening and prevention","volume":"145","author":"Poon LC","year":"2019","journal-title":"Int J Gynaecol Obstet"},{"issue":"5","key":"e_1_2_12_10_1","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1002\/uog.15807","article-title":"Contingent screening for preterm pre\u2010eclampsia","volume":"47","author":"Wright D","year":"2016","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"5","key":"e_1_2_12_11_1","first-page":"329","article-title":"Guideline for the prediction and prevention of pre\u2010eclampsia (2025)","volume":"60","author":"Chinese Society of Obstetrics and Gynecology","year":"2025","journal-title":"Chin J Obstet Gynecol"},{"issue":"5","key":"e_1_2_12_12_1","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1007\/s00404-012-2662-2","article-title":"Is serum placental growth factor more effective as a biomarker in predicting early onset preeclampsia in early second trimester than in first trimester of pregnancy?","volume":"287","author":"Ghosh SK","year":"2013","journal-title":"Arch Gynecol Obstet"},{"issue":"2","key":"e_1_2_12_13_1","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.preghy.2011.11.006","article-title":"Association between placental growth factor levels in early onset preeclampsia with the occurrence of postpartum hemorrhage: a prospective cohort study","volume":"2","author":"Ghosh SK","year":"2012","journal-title":"Pregnancy Hypertens"},{"issue":"1","key":"e_1_2_12_14_1","first-page":"56","article-title":"First\u2010trimester PlGF and PAPP\u2010A and the risk of placenta\u2010mediated complications: PREDICTION prospective study","volume":"63","author":"Tan MY","year":"2024","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"5","key":"e_1_2_12_15_1","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1002\/uog.27513","article-title":"Placental growth factor and fetoplacental doppler indices in combination predict preterm birth reliably in pregnancies complicated by fetal growth restriction","volume":"63","author":"Hong J","year":"2024","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"8","key":"e_1_2_12_16_1","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1042\/CS20220300","article-title":"Circulating biomarkers associated with placental dysfunction and their utility for predicting fetal growth restriction","volume":"137","author":"Hong J","year":"2023","journal-title":"Clin Sci (Lond)"},{"issue":"2","key":"e_1_2_12_17_1","doi-asserted-by":"crossref","first-page":"S1019","DOI":"10.1016\/j.ajog.2020.10.022","article-title":"Imbalances in circulating angiogenic factors in the pathophysiology of preeclampsia and related disorders","volume":"226","author":"Rana S","year":"2022","journal-title":"Am J Obstet Gynecol"},{"issue":"2","key":"e_1_2_12_18_1","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1002\/uog.26032","article-title":"Clinical utility of sFlt\u20101 and PlGF in screening, prediction, diagnosis and monitoring of pre\u2010eclampsia and fetal growth restriction","volume":"61","author":"Stepan H","year":"2023","journal-title":"Ultrasound Obstet Gynecol"},{"key":"e_1_2_12_19_1","doi-asserted-by":"crossref","DOI":"10.3389\/fendo.2025.1674540","article-title":"Association of placental growth factor with the risk of adverse pregnancy outcomes: a prospective cohort study in Chinese pregnant women","volume":"16","author":"Li TS","year":"2025","journal-title":"Front Endocrinol (Lausanne)"},{"issue":"11","key":"e_1_2_12_20_1","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2024.44454","article-title":"Midpregnancy placental growth factor screening and early preterm birth","volume":"7","author":"Gladstone RA","year":"2024","journal-title":"JAMA Netw 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