{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T13:10:10Z","timestamp":1778937010461,"version":"3.51.4"},"reference-count":38,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,2,22]],"date-time":"2026-02-22T00:00:00Z","timestamp":1771718400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,2,22]],"date-time":"2026-02-22T00:00:00Z","timestamp":1771718400000},"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":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To assess the predictive performance of angiogenic factors and fetal Doppler, alone and in combination, for composite adverse perinatal outcome (CAPO) in early\u2010onset small\u2010for\u2010gestational age (SGA) and fetal growth restriction (FGR), in cases both with and without pre\u2010eclampsia (PE), in order to evaluate the ability of these markers to predict adverse outcomes beyond their established association with PE and to better delineate the specific contribution of PE to their predictive value.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This was a retrospective observational study conducted at Vall d'Hebron University Hospital, Barcelona, Spain, between January 2016 and January 2022. The study population included singleton pregnancies with an estimated fetal weight &lt;\u200910\n                      <jats:sup>th<\/jats:sup>\n                      percentile, diagnosed with fetal smallness between 20\u2009+\u20090 and 31\u2009+\u20096\u2009weeks' gestation, with fetal Doppler ultrasound data and available angiogenic factor measurements obtained at diagnosis. Placental growth factor (PlGF) and soluble fms\u2010like tyrosine kinase\u20101 (sFlt\u20101) were measured at initial assessment. CAPO was defined as the presence of at least one of the following: 5\u2010min Apgar score &lt;\u20097; umbilical cord arterial pH &lt;\u20097.0; admission to the neonatal intensive care unit for\u2009&gt;\u200948\u2009h; stillbirth; neonatal death; respiratory distress syndrome; bronchopulmonary dysplasia; neonatal sepsis; necrotizing enterocolitis; Grade\u2010III\u2013IV retinopathy of prematurity; Grade\u2010III\u2013IV intraventricular hemorrhage; or periventricular leukomalacia. Predictive performance for CAPO and subsequent PE was assessed using receiver\u2010operating\u2010characteristics (ROC)\u2010curve analysis and area under the ROC curve (AUC) comparisons for fetal Doppler and angiogenic factors, alone and combined, within logistic regression models. Sensitivity, false\u2010positive rate, positive predictive value and negative predictive value were calculated. All analyses were stratified according to PE development at any time before delivery.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Overall, 469 women with an early\u2010onset small fetus were included. PE was present at diagnosis in 74\/469 (15.8%) cases and developed later in 83 (17.7%) cases. CAPO occurred in 46.5% of cases. In the overall cohort, PlGF combined with fetal Doppler findings showed the highest predictive performance for CAPO (AUC, 0.866 (95%\u2009CI, 0.833\u20130.899)), outperforming fetal Doppler alone. Notably, the performance of the combined model was not significantly different from PlGF alone (AUC, 0.862 (95%\u2009CI, 0.828\u20130.895);\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.621). These findings were consistent in pregnancies without PE, in which PlGF remained the best\u2010performing single predictor of CAPO (AUC, 0.797 (95%\u2009CI, 0.740\u20130.854)). In pregnancies with PE at any time, the best\u2010performing single predictor was the sFlt\u20101\/PlGF ratio (AUC, 0.802 (95%\u2009CI, 0.728\u20130.876)). For the prediction of subsequent PE after enrolment, the sFlt\u20101\/PlGF ratio alone (AUC, 0.861 (95%\u2009CI, 0.821\u20130.901)) and in combination with fetal Doppler (AUC, 0.862 (95%\u2009CI, 0.822\u20130.902)) achieved the highest predictive performance. Combining fetal Doppler findings with angiogenic factors reduced false\u2010positive rates, but did not improve sensitivity.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      This study confirmed the robust predictive performance of PlGF and the sFlt\u20101\/PlGF ratio for identifying CAPO and PE in early\u2010onset SGA\/FGR. The\u00a0predictive value of PlGF and fetal Doppler remained consistent irrespective of PE status, while the sFlt\u20101\/PlGF ratio showed reduced predictive accuracy in non\u2010PE pregnancies, but still outperformed Doppler. These findings support the integration of angiogenic factors into the clinical assessment of early\u2010onset SGA\/FGR, for both cases with and those without PE. \u00a9 2026 The Author(s).\n                      <jats:italic>Ultrasound in Obstetrics &amp; Gynecology<\/jats:italic>\n                      published by John Wiley &amp; Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/uog.70188","type":"journal-article","created":{"date-parts":[[2026,2,22]],"date-time":"2026-02-22T21:40:35Z","timestamp":1771796435000},"page":"482-491","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Angiogenic factors and fetal\n                    <scp>Doppler<\/scp>\n                    for predicting adverse pregnancy outcome in early\u2010onset small fetuses with and without pre\u2010eclampsia"],"prefix":"10.1002","volume":"67","author":[{"given":"E.","family":"Bonacina","sequence":"first","affiliation":[{"name":"Department of Obstetrics Vall d'Hebron Barcelona Hospital Campus  Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"Armengol\u2010Alsina","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Vall d'Hebron Barcelona Hospital Campus  Barcelona Spain"},{"name":"Departament de Pediatria Obstetr\u00edcia i Ginecologia i de Medicina Preventiva i Salut P\u00fablica, Universitat Aut\u00f2noma de Barcelona  Bellaterra Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Casellas","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Vall d'Hebron Barcelona Hospital Campus  Barcelona 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