{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T18:07:43Z","timestamp":1789754863070,"version":"4.0.1"},"reference-count":31,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To compare risk factors between preeclampsia-associated fetal growth restriction (PFGR) and non-preeclamptic vascular FGR (VFGR) in a cohort of 96,094 consecutive singleton non-malformed pregnancies (\u226522 weeks gestation) to identify susceptibility and protective factors differentiating maternal tolerance from overt hypertensive disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Observational population-based cohort study over 24.5 years at a university maternity center.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 94,435 non-malformed births, 9,356 (10.0%) were SGA, with 2,060 (22%) classified as FGR based on abnormal Doppler indices: 529 PFGR (25.7%) and 1,531 VFGR (74.3%). VFGR predominated in late-onset cases (\u226534 weeks; 78% vs. 46% early-onset &lt;34 weeks). Compared to VFGR, PFGR mothers were older (mean 28 vs. 27 years), had higher pre-pregnancy BMI (25.9\u201326.8 vs. 24.0\u201324.4 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ), and greater gestational weight gain (by 1\u20133 kg). Obesity (BMI\u2009\u2265\u200930 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ) increased PFGR risk (OR 1.4\u20132.1), while underweight (BMI\u2009&lt;\u200918.5 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ) (OR 0.36\u20130.50) and smoking (OR 0.36\u20130.51) was protective for PFGR. Chronic hypertension (OR 2.8\u20133.0), previous preeclampsia (OR 3.3\u20139.9 in multiparas), primipaternity (OR 2.1\u20136.8), and renal disease (OR 5.0\u20137.8) were key risks for PFGR, with stronger effects in early-onset. Neonatal outcomes were similarly poor in early-onset PFGR\/VFGR but worse in late-onset PFGR (e.g., higher prematurity, fetal death). Multivariable models confirmed independent associations of PFGR with age, BMI, chronic hypertension, primipaternity, previous abortion, and smoking (protective).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study reveals VFGR as the majority of placental-mediated FGR, with PFGR distinguished by metabolic, vascular, and immunological risks. These insights prioritize research into maternal protective mechanisms, potentially enabling targeted predictions and interventions to mitigate FGR\u2019s impacts on mothers and offspring.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0354687","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T17:31:46Z","timestamp":1789752706000},"page":"e0354687","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Why only one-quarter of placental fetal growth restriction triggers preeclampsia? Clinical risk factors in 2060 cases in a 24-year cohort of 90,000 births"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8916-9045","authenticated-orcid":true,"given":"Pierre-Yves","family":"Robillard","sequence":"first","affiliation":[{"name":"Service de N\u00e9onatologie, Centre Hospitalier Universitaire Sud R\u00e9union","place":["Saint-Pierre Cedex, La R\u00e9union"]},{"name":"Centre d\u2019Etudes P\u00e9rinatales Oc\u00e9an Indien (CEPOI). Centre Hospitalier Universitaire Sud R\u00e9union","place":["Saint-Pierre cedex, La r\u00e9union"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gustaaf","family":"Dekker","sequence":"additional","affiliation":[{"name":"University of Adelaide, Robinson Institute, Lyell McEwin Hospital","place":["Adelaide, Australia"],"department":["Department of Obstetrics & Gynaecology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nandor Gabor","family":"Than","sequence":"additional","affiliation":[{"name":"Systems Biology of Reproduction Research Group, Institute of Molecular Life Sciences, HUN-REN Research Center for Natural Sciences","place":["Budapest, Hungary"]},{"name":"School of Medicine, Semmelweis University","place":["Budapest, Hungary"],"department":["Department of Obstetrics and Gynaecology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Bonsante","sequence":"additional","affiliation":[{"name":"Service de N\u00e9onatologie, Centre Hospitalier Universitaire Sud R\u00e9union","place":["Saint-Pierre Cedex, La R\u00e9union"]},{"name":"Centre d\u2019Etudes P\u00e9rinatales Oc\u00e9an Indien (CEPOI). Centre Hospitalier Universitaire Sud R\u00e9union","place":["Saint-Pierre cedex, La r\u00e9union"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malik","family":"Boukerrou","sequence":"additional","affiliation":[{"name":"Centre d\u2019Etudes P\u00e9rinatales Oc\u00e9an Indien (CEPOI). Centre Hospitalier Universitaire Sud R\u00e9union","place":["Saint-Pierre cedex, La r\u00e9union"]},{"name":"Service \u200c\u200cde Gyn\u00e9cologie et Obst\u00e9trique. Centre Hospitalier Universitaire Sud R\u00e9union","place":["Saint-Pierre cedex, La r\u00e9union"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Scioscia","sequence":"additional","affiliation":[{"name":"Mater Dei Hospital","place":["Bari, Italy"],"department":["Department of Obstetrics and Gynaecology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3283-1450","authenticated-orcid":true,"given":"Phuong Lien","family":"Tran","sequence":"additional","affiliation":[{"name":"Service \u200c\u200cde Gyn\u00e9cologie et Obst\u00e9trique. 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