Oral Concurrent Session 9
115: Prediction of late onset fetal growth restriction using circulating placental RNA in the maternal blood

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Objective

Late onset fetal growth restriction (FGR) is rarely identified prior to birth leading to adverse perinatal outcomes. Currently, no effective biomarkers exist to identify pregnancies at risk of late onset FGR. Circulating RNA can provide insight into placental function, therefore we sought to determine if placental specific circulating RNA in maternal blood at 26-30 weeks could identify pregnancies at risk of late onset FGR.

Study Design

A nested case-control study from a prospective study of 600 women recruited at 26-30 weeks gestation. Maternal whole blood was collected at the time of gestational diabetes screening. RNA was isolated using the PAXgene system. The circulating placental transcriptome was compared between women who subsequently delivered a growth restricted (37 weeks) and women delivering a well grown control (matched 1:2). Using in silica analysis we have previously identified placental specific RNA which we

Results

40 women developed late onset FGR (bwt 2640g, 2nd centile). 80 matched controls delivered a well grown term neonate (3349g, 53rd centile, p<0.05). Operative delivery and neonatal admission was higher in the FGR cohort (45% vs 23%, p<0.05). 37 placental specific genes were differentially expressed on the microarray, 7 of which were significantly up-regulated with PCR validation (p<0.05). A 4 gene signature predicted late onset FGR with an AUC 0.75. Combining the gene signature with maternal

Conclusion

A unique placental transcriptome in pregnancies destined to develop late onset FGR is detectable in the maternal blood at 26-30 weeks gestation. Early antenatal detection, surveillance and timely delivery may prevent adverse outcomes in these pregnancies at risk of late onset FGR.

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