{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T17:00:20Z","timestamp":1785085220043,"version":"3.55.0"},"reference-count":25,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T00:00:00Z","timestamp":1784937600000},"content-version":"vor","delay-in-days":24,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["American J Rep Immunol"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Fetal growth restriction (FGR) is a major cause of perinatal morbidity and is frequently associated with placental malperfusion related to inflammatory and immune dysregulation. This study evaluated whether the first\u2010trimester maternal C\u2010reactive protein\u2013albumin\u2013lymphocyte (CALLY) index, a composite marker reflecting systemic inflammation, nutritional status, and immune competence, is associated with subsequent FGR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective case\u2010control study included 105 singleton pregnancies (69 FGR cases and 36 controls) at a tertiary center. FGR was diagnosed according to Delphi consensus criteria. The first\u2010trimester CALLY index was calculated as (albumin \u00d7 lymphocyte count) \/ CRP. Placental histopathology was evaluated according to the Amsterdam Placental Workshop Group criteria. Group comparisons were performed using the Mann\u2013Whitney U test and chi\u2010square or Fisher's exact test, and diagnostic performance was assessed using receiver operating characteristic (ROC) analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The CALLY index was significantly lower in the FGR group compared with controls (0.065\u00a0vs 0.170,\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001). FGR cases also had lower birthweight (1910\u00a0vs 3120\u00a0g,\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001) and placental weight (344.5\u00a0vs 585\u00a0g,\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001). Maternal vascular malperfusion (MVM) was more frequent in the FGR group (39.1%\u00a0vs 13.9%,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.015), while fetal vascular malperfusion (FVM) showed borderline significance (63.8%\u00a0vs 41.7%,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.050). ROC analysis demonstrated modest discriminatory ability for identifying FGR (AUC = 0.739, 95% CI: 0.652\u20130.826). A CALLY threshold \u22640.1265 yielded 75.4% sensitivity and 66.7% specificity. After adjustment for maternal age, low CALLY remained significantly associated with FGR (adjusted OR: 6.118, 95% CI: 2.529\u201314.799,\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001). Early\u2010onset FGR cases (\u226434 weeks) showed the lowest CALLY values (0.051). Additional ROC analyses for placental malperfusion endpoints showed limited discriminatory ability (AUCs: 0.592\u20130.636), indicating that CALLY is not a reliable standalone predictor of placental pathology.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A low first\u2010trimester maternal CALLY index is associated with subsequent FGR. Its modest discriminatory ability for FGR (AUC = 0.739) suggests it may serve as a complementary tool in multi\u2010parameter risk assessment, particularly when integrated with clinical and sonographic findings. However, the limited performance for placental malperfusion endpoints indicates that CALLY should not be used as a standalone test for predicting placental pathology. Further prospective studies are needed to define its clinical role.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aji.70301","type":"journal-article","created":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T07:36:13Z","timestamp":1784964973000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["First\u2010Trimester Maternal CALLY Index Is Associated With Fetal Growth Restriction"],"prefix":"10.1111","volume":"96","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6592-4533","authenticated-orcid":false,"given":"Esra","family":"Karakus","sequence":"first","affiliation":[{"name":"Department of Pathology Turkish Ministry of Health, Ankara Bilkent City Hospital  Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4552-8155","authenticated-orcid":false,"given":"Ali Furkan","family":"Yahsi","sequence":"additional","affiliation":[{"name":"Department of Pathology Turkish Ministry of Health, Ankara Bilkent City Hospital  Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5471-6109","authenticated-orcid":false,"given":"Kubra","family":"Katipoglu","sequence":"additional","affiliation":[{"name":"Department of Pathology Turkish Ministry of Health, Ankara Bilkent City Hospital  Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,25]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.15884"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000004251"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2022.08.010"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/rfc2.70013"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-024-06335-z"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1084\/jem.20130295"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2023.1131496"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers13195018"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.5858\/arpa.2015\u20100225\u2010CC"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.placenta.2015.03.006"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2011.03.049"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0319494"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2024.1266669"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2021.09.016"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0107880"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/aji.70062"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/apm.12833"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.modpat.2023.100370"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hpb.2021.06.414"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1186\/s41927\u2010025\u201000499\u20107"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2023.1131496"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598\u2010025\u201097538\u20107"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404\u2010016\u20104024\u2010y"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884\u2010018\u20101992\u2010x"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.15879"}],"container-title":["American 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