{ "abstract": "Objectives: 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 (≥22 weeks gestation) to identify susceptibility and protective factors differentiating maternal tolerance from overt hypertensive disease. Design: Observational population-based cohort study over 24.5 years at a university maternity center. Results: 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 (≥34 weeks; 78% vs. 46% early-onset <34 weeks). Compared to VFGR, PFGR mothers were older (mean 28 vs. 27 years), had higher pre-pregnancy BMI (25.9–26.8 vs. 24.0–24.4 kg/m2), and greater gestational weight gain (by 1–3 kg). Obesity (BMI ≥ 30 kg/m2) increased PFGR risk (OR 1.4–2.1), while underweight (BMI < 18.5 kg/m2) (OR 0.36–0.50) and smoking (OR 0.36–0.51) was protective for PFGR. Chronic hypertension (OR 2.8–3.0), previous preeclampsia (OR 3.3–9.9 in multiparas), primipaternity (OR 2.1–6.8), and renal disease (OR 5.0–7.8) 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). Conclusions: 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’s impacts on mothers and offspring.", "abstract_shown": true, "affiliations": [ "Service de Néonatologie, Centre Hospitalier Universitaire Sud Réunion, Saint-Pierre Cedex, La Réunion", "Centre d’Etudes Périnatales Océan Indien (CEPOI). Centre Hospitalier Universitaire Sud Réunion, Saint-Pierre cedex, La réunion", "Department of Obstetrics & Gynaecology, University of Adelaide, Robinson Institute, Lyell McEwin Hospital, Adelaide, Australia", "Systems Biology of Reproduction Research Group, Institute of Molecular Life Sciences, HUN-REN Research Center for Natural Sciences, Budapest, Hungary", "Department of Obstetrics and Gynaecology, School of Medicine, Semmelweis University, Budapest, Hungary", "Service ‌‌de Gynécologie et Obstétrique. Centre Hospitalier Universitaire Sud Réunion, Saint-Pierre cedex, La réunion", "Department of Obstetrics and Gynaecology, Mater Dei Hospital, Bari, Italy" ], "article_type": "Research Article", "arxiv": null, "author_total": 8, "authors": [ { "affs": [ 0 ], "name": "Pierre-Yves Robillard" }, { "affs": [ 1 ], "name": "Gustaaf Dekker" }, { "affs": [ 2 ], "name": "Nandor Gabor Than" }, { "affs": [ 3 ], "name": "Francesco Bonsante" }, { "affs": [ 4 ], "name": "Malik Boukerrou" }, { "affs": [ 5 ], "name": "Marco Scioscia" }, { "affs": [ 6 ], "name": "Phuong Lien Tran" }, { "name": "Silvia Iacobelli" } ], "bibtex": "https://research.draconitic.com/paper/aedh1b84a8qyx.bib", "cited_by": 0, "doi": "10.1371/journal.pone.0354687", "fulltext_url": null, "id": "aedh1b84a8qyx", "issns": [ "1932-6203" ], "landing_url": "https://doi.org/10.1371/journal.pone.0354687", "language": null, "licence": "CC-BY-4.0", "licence_label": "CC BY 4.0", "licence_source": "journal", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "openalex", "2729|Pregnancy and preeclampsia studies" ], [ "plos", "/Biology and life sciences/Anatomy/Reproductive system/Placenta" ], [ "plos", "/Biology and life sciences/Developmental biology/Embryology/Placenta" ], [ "plos", "/Biology and life sciences/Developmental biology/Neonates" ], [ "plos", "/Medicine and health sciences/Anatomy/Reproductive system/Placenta" ], [ "plos", "/Medicine and health sciences/Cardiology/Cardiovascular medicine/Cardiovascular diseases/Cardiovascular disease risk" ], [ "plos", "/Medicine and health sciences/Medical conditions/Cardiovascular diseases/Cardiovascular disease risk" ], [ "plos", "/Medicine and health sciences/Pediatrics/Child development/Child growth/Growth restriction" ], [ "plos", "/Medicine and health sciences/Vascular medicine/Blood pressure/Hypertension/Hypertensive disorders in pregnancy" ], [ "plos", "/Medicine and health sciences/Women's health/Maternal health/Birth/Labor and delivery" ], [ "plos", "/Medicine and health sciences/Women's health/Maternal health/Pregnancy" ], [ "plos", "/Medicine and health sciences/Women's health/Maternal health/Pregnancy/Hypertensive disorders in pregnancy" ], [ "plos", "/Medicine and health sciences/Women's health/Maternal health/Pregnancy/Pregnancy complications/Preeclampsia" ], [ "plos", "/Medicine and health sciences/Women's health/Obstetrics and gynecology/Birth/Labor and delivery" ], [ "plos", "/Medicine and health sciences/Women's health/Obstetrics and gynecology/Pregnancy" ], [ "plos", "/Medicine and health sciences/Women's health/Obstetrics and gynecology/Pregnancy/Hypertensive disorders in pregnancy" ], [ "plos", "/Medicine and health sciences/Women's health/Obstetrics and gynecology/Pregnancy/Pregnancy complications/Preeclampsia" ] ], "openalex": "W7213548872", "pdf_url": "https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0354687&type=printable", "pmcid": null, "pmid": null, "published": "2026-09-18", "publisher": "Public Library of Science", "ris": "https://research.draconitic.com/paper/aedh1b84a8qyx.ris", "sources": [ { "first_seen": "2026-10-30T12:17:49Z", "native_id": "10.1371/journal.pone.0354687", "source": "plos", "url": "https://doi.org/10.1371/journal.pone.0354687" } ], "subjects": [ { "field": "medicine", "origin": "plos:pediatrics", "subfield": "reproductive-child" } ], "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", "title_text": "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", "type": "peer-reviewed", "updated_at": "2026-10-30T12:17:49Z", "url": "https://research.draconitic.com/paper/aedh1b84a8qyx", "venue": "PLOS One", "versions": [] }