Screening for fetal growth restriction using ultrasound and the sFLT1/PlGF ratio in nulliparous women: a prospective cohort study  Francesca Gaccioli, PhD, Ulla Sovio, PhD, Emma Cook, BSc, Martin Hund, PhD, Prof D Stephen Charnock-Jones, PhD, Prof Gordon C S Smith, DSc  The Lancet Child & Adolescent Health  Volume 2, Issue 8, Pages 569-581 (August 2018) DOI: 10.1016/S2352-4642(18)30129-9 Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Terms and Conditions

Figure 1 Cumulative incidence graphs (A) Preterm delivery of a small for gestational age infant (birthweight below the tenth customised percentile) following 28 weeks of gestational age measurement by screening status. Screen positivity was defined as estimated fetal weight below the tenth percentile for gestational age, combined with a sFLT1/PlGF ratio greater than 5·78. Number at risk 3934 screen negatives and 47 screen positives. (B) Delivery of a small for gestational age infant plus a complication following 36 weeks of gestational age measurement by screening status. Screen positivity was defined as an estimated fetal weight below the tenth percentile for gestational age, combined with sFLT1/PlGF ratio more than 38. Number at risk 3645 screen negatives and 102 screen positives. Small for gestational age was defined as birthweight below the tenth population-based percentile and a complication was defined as one or more of the following: non-anomalous perinatal death, any neonatal morbidity, or maternal pre-eclampsia. The number at risk increases before it decreases because the majority of women had their scan and blood sample taken after 28 weeks and zero days (A) or after 36 weeks and zero days (B). sFLT1=soluble fms-like tyrosine kinase 1. PlGF=placental growth factor. The Lancet Child & Adolescent Health 2018 2, 569-581DOI: (10.1016/S2352-4642(18)30129-9) Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Terms and Conditions

Figure 2 ROC curve analysis (A) Relationship between the sFLT1/PlGF ratio at 28 weeks of gestational age and the risk of pre-eclampsia with delivery of a preterm small for gestational age infant (birthweight below the tenth customised percentile; n=12 cases). (B) Relationship between the sFLT1/PlGF ratio at 28 weeks of gestational age and the risk of pre-eclampsia with delivery of a preterm non-small for gestational age infant (birthweight at or above the tenth customised percentile; n=14 cases). (C) Relationship between the sFLT1/PlGF ratio at 36 weeks of gestational age and the risk of pre-eclampsia with delivery of a small for gestational age infant (birthweight below the tenth population-based percentile; n=21 cases). (D) Relationship between the sFLT1/PlGF ratio at 36 weeks of gestational age and the risk of pre-eclampsia with delivery of a non-small for gestational age infant (birthweight at or above the tenth population-based percentile; n=203 cases). ROC=receiver operating characteristic. sFLT1=soluble fms-like tyrosine kinase 1. PlGF=placental growth factor. The Lancet Child & Adolescent Health 2018 2, 569-581DOI: (10.1016/S2352-4642(18)30129-9) Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Terms and Conditions