{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:04:39Z","timestamp":1791331479124,"version":"4.3.1"},"reference-count":118,"publisher":"Walter de Gruyter GmbH","issue":"3","license":[{"start":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T00:00:00Z","timestamp":1767744000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"NICHD\/NIH\/DHHS","award":["HHSN275201300006C"],"award-info":[{"award-number":["HHSN275201300006C"]}]},{"DOI":"10.13039\/100000865","name":"Bill & Melinda Gates Foundation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,26]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_jpm-2025-0624_abs_001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Fetal death is a major pregnancy complication, with rates of 5.5 per 1,000 births in the United\u00a0States and substantially higher in India (24.7\/1,000) and Pakistan (44.5\/1,000). Maternal vascular malperfusion (MVM) is the most frequent placental lesion associated with fetal death, occurring in 58\u202f% of fetal deaths and 31\u202f% of preterm neonatal deaths in South Asia. Angiogenic imbalance, characterized by a low placental growth factor (PlGF) to soluble fms-like tyrosine kinase-1 (sFlt-1) ratio, has been associated with MVM and fetal death in high-income countries. We examined whether maternal serum concentrations of PlGF, sFlt-1, and their ratio differ between mothers with and without MVM among stillbirths and preterm neonatal deaths in India and Pakistan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jpm-2025-0624_abs_002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective cohort analysis used data from the PURPOSe study (Project to Understand and Research Preterm Pregnancy Outcomes and Stillbirths in South Asia). Maternal blood was collected at delivery, and placental histopathology was classified according to the Amsterdam criteria. Serum PlGF and sFlt-1 were measured using Elecsys\n                      <jats:sup>\u00ae<\/jats:sup>\n                      immunoassays, with analyses stratified by gestational\u00a0age.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jpm-2025-0624_abs_003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Placental MVM was present in 44\u201357\u202f% of stillbirths and 31\u201338\u202f% of preterm neonatal deaths. Between 28 and 36\u00a0weeks, women with MVM had significantly lower PlGF and higher sFlt-1 and sFlt-1\/PlGF ratios\u00a0(p&lt;0.001). A tenfold decrease in PlGF or increase in the ratio was associated with MVM (OR 0.5 and 1.7, respectively).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jpm-2025-0624_abs_004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The maternal sFlt-1\/PlGF ratio identifies pregnancies with fetal or neonatal death associated with placental MVM, particularly between 28 and 36\u00a0weeks\u2019 gestation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/jpm-2025-0624","type":"journal-article","created":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T04:56:39Z","timestamp":1767761799000},"page":"550-565","source":"Crossref","is-referenced-by-count":2,"title":["Maternal circulating sFlt-1\/placental growth factor is a biomarker of fetal death associated with placental lesions of maternal vascular malperfusion"],"prefix":"10.1515","volume":"54","author":[{"given":"Tinnakorn","family":"Chaiworapongsa","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology , Wayne State University School of Medicine , Detroit , MI , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Romero","sequence":"additional","affiliation":[{"name":"Division of Intramural Research , Pregnancy Research Branch, Eunice Kennedy Shriver National Institute of Child Health and\u00a0Human Development, National Institutes of Health, United\u00a0States\u00a0Department of Health and Human Services , Bethesda , MD , USA"},{"name":"Department of Obstetrics and Gynecology , University of Michigan , Ann Arbor , MI , USA"},{"name":"Department of Epidemiology and Biostatistics , Michigan State University , East Lansing , MI , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth M.","family":"McClure","sequence":"additional","affiliation":[{"name":"Social, Statistical and Environmental Health Sciences, RTI International , Durham , NC , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shivaprasad","family":"Goudar","sequence":"additional","affiliation":[{"name":"Women\u2019s and Children\u2019s Health Research Unit, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research , Belagavi , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manjunath","family":"Somannavar","sequence":"additional","affiliation":[{"name":"Women\u2019s and Children\u2019s Health Research Unit, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research , Belagavi , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiyam Sunder","family":"Tikmani","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences, Aga Khan University , Karachi , Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Saleem","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences, Aga Khan University , Karachi , Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Najia","family":"Ghanchi","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine , Aga Khan University , Karachi , Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Imran","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine , Aga Khan University , Karachi , Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afia","family":"Zafar","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine , Aga Khan University , Karachi , Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanyukta","family":"Patil","sequence":"additional","affiliation":[{"name":"Women\u2019s and Children\u2019s Health Research Unit, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research , Belagavi , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunilkumar","family":"BK","sequence":"additional","affiliation":[{"name":"Jagadguru Jayadeva Murugarajendra Medical College , Davangere , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yogeshkumar","family":"S","sequence":"additional","affiliation":[{"name":"Women\u2019s and Children\u2019s Health Research Unit, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research , Belagavi , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean","family":"Kim","sequence":"additional","affiliation":[{"name":"Social, Statistical and Environmental Health Sciences, RTI International , Durham , NC , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet","family":"Moore","sequence":"additional","affiliation":[{"name":"Social, Statistical and Environmental Health Sciences, RTI International , Durham , NC , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arun","family":"Meyyazhagan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology , Wayne State University School of Medicine , Detroit , MI , USA"},{"name":"Division of Intramural Research , Pregnancy Research Branch, Eunice Kennedy Shriver National Institute of Child Health and\u00a0Human Development, National Institutes of Health, United\u00a0States\u00a0Department of Health and Human Services , Bethesda , MD , USA"},{"name":"Department of Life Sciences , Christ University , Bengaluru , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Awoniyi","family":"Awonuga","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology , Wayne State University School of Medicine , Detroit , MI , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dereje","family":"Gudicha","sequence":"additional","affiliation":[{"name":"Division of Intramural Research , Pregnancy Research Branch, Eunice Kennedy Shriver National Institute of Child Health and\u00a0Human Development, National Institutes of Health, United\u00a0States\u00a0Department of Health and Human Services , Bethesda , MD , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adi L.","family":"Tarca","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology , Wayne State University School of Medicine , Detroit , MI , USA"},{"name":"Center for Molecular Medicine and Genetics , Wayne State University , Detroit , MI , USA"},{"name":"Department of Computer Science , Wayne State University College of Engineering , Detroit , MI , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert L.","family":"Goldenberg","sequence":"additional","affiliation":[{"name":"Columbia University , New York , NY , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2026,1,7]]},"reference":[{"key":"2026051215133570301_j_jpm-2025-0624_ref_001","doi-asserted-by":"crossref","unstructured":"Comfort, H, McHugh, TA, Schumacher, AE, Harris, A, May, EA, Paulson, KR, et al.. 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