Maternal Serum Placental Growth Factor and Uterine Artery Pulsatility Index for Early‐Onset Preeclampsia Prediction in Chinese Women: A Retrospective Cohort Study

Background Early‐onset preeclampsia (EOPE) accounts for a disproportionate share of severe maternal–fetal complications. First‐trimester screening based on traditional risk factors alone lacks sufficient sensitivity. We evaluated whether maternal serum placental growth factor (PlGF) and uterine artery pulsatility index (UtA‐PI), alone or in combination, enhance first‐trimester prediction of EOPE in a Chinese cohort. Methods This retrospective cohort study recruited 680 singleton pregnancies delivered in our centre between January 2022 and January 2025. After excluding pre‐existing diseases and other pregnancy complications, 120 EOPE cases delivered < 34 weeks were compared with 480 normotensive controls. Maternal serum PlGF and UtA‐PI were measured at 11–13 +6 and 14–24 +6 weeks. Logistic regression and ROC analyses were used to assess predictive performance. Results In early pregnancy, women who later developed EOPE exhibited lower PlGF (36.8 ± 15.3 vs. 89.7 ± 23.5 pg/mL, p < 0.001) and higher UtA‐PI (1.90 ± 0.60 vs. 1.20 ± 0.30, p < 0.001) than controls. Both markers were independent predictors in multivariable models (PlGF OR 0.95, UtA‐PI OR 1.82; both p < 0.001). ROC curves indicated that combined assessment yielded superior discrimination: early‐pregnancy AUC 0.94 (95% CI 0.90–0.98) and mid‐pregnancy AUC 0.87 (0.82–0.92), both exceeding single‐marker performance ( p < 0.05). Optimal cut‐offs in early pregnancy (PlGF ≤ 62.5 pg/mL and UtA‐PI ≥ 1.5) provided 82.5% sensitivity and 88.3% specificity. Conclusions Combining PlGF and UtA‐PI significantly improved first‐trimester prediction of EOPE. These findings establish a foundation for population‐level implementation of this dual‐marker strategy to reduce the burden of early‐onset preeclampsia.