Placental insufficiency is central to the pathophysiology of fetal growth restriction (FGR), yet antenatal differentiation from constitutionally small fetuses remains challenging. In this secondary analysis of the DRIGITAT trial, placental histopathology was correlated with Doppler findings, biomarkers, and perinatal outcomes in late-preterm small-for-gestational-age (SGA) pregnancies. High-grade maternal vascular malperfusion (MVM) and fetal vascular malperfusion (FVM) were significantly more prevalent in fetuses with clinical FGR compared with SGA without Doppler abnormalities and were independently associated with adverse perinatal outcomes.
Abnormal Doppler indices (umbilicocerebral ratio >0.8 or umbilical artery PI >p90) and altered angiogenic biomarkers were strongly linked to high-grade placental lesions. These findings reinforce that FGR represents a distinct placental disease…
