The sFlt-1/PlGF Index as an Auxiliary Tool in the Prediction of Adverse Perinatal Outcomes in Late-Onset Fetal Growth Restriction: A Systematic Review

Background/Objectives: This study evaluates the prognostic utility of placental insufficiency biomarkers in late-onset fetal growth restriction occurring after 32 weeks of gestation. These markers were assessed both independently and in conjunction with ultrasound and Doppler indices to predict adverse perinatal outcomes. Given the clinical integration of maternal angiogenic factor assessment, it is imperative to determine whether these markers—specifically the sFlt-1/PlGF ratio—can effectively mitigate fetal and neonatal morbidity and mortality. Methods: This review is registered with PROSPERO and encompasses the literature from the last decade. The present analysis incorporated prospective observational cohort studies. Four comprehensive databases were queried, resulting in the evaluation of fifty-one relevant records. Thirty-six full-text articles were assessed for eligibility, resulting in the inclusion of six relevant manuscripts. The total sample size was 14.499 patients. Detection rates for growth restricted fetuses demonstrated significant variability, ranging from 15% to 88.5%. Conclusions: The clinical utility of angiogenic biomarkers for the prediction of fetal growth restriction remains unresolved; moreover, the empirical evidence synthesized within this review exhibits a significant degree of heterogeneity.