Original Investigation

Maternal Circulating sFlt-1:PlGF Ratio and Stillbirth

JAMA Network Open 10.1001/jamanetworkopen.2026.7652

April 17, 2026 at 11:00 AM EDT

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Is an elevated ratio of soluble fms-like tyrosine kinase-1 (sFlt-1) to reduced placental growth factor (PlGF) using clinically relevant cutoffs associated with an increased risk of stillbirth?In this case-control study of 39 stillbirths and 86 live births, a high sFlt-1:PlGF ratio was significantly associated with a 13-fold greater odds of stillbirth at the clinical cutoffs.These findings suggest that placental angiogenic imbalance may contribute to the pathogenesis of stillbirth in low-resource settings.

Corresponding Author: Mi-Sun S. Lee, PhD, Department of Environmental Health, Harvard T.H. Chan School of Public Health, 665 Huntington Ave, FXB Bldg, Room 103, Boston, MA 02115 (mslee@hsph.harvard.edu).

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