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Circulating SPINT1 is a biomarker of pregnancies with poor placental function and fetal growth restriction

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Kaitu’u-Lino, Tu’uhevaha J. 
MacDonald, Teresa M.  ORCID logo
Cannon, Ping 
Nguyen, Tuong-Vi 
Hiscock, Richard J. 


Abstract: Placental insufficiency can cause fetal growth restriction and stillbirth. There are no reliable screening tests for placental insufficiency, especially near-term gestation when the risk of stillbirth rises. Here we show a strong association between low circulating plasma serine peptidase inhibitor Kunitz type-1 (SPINT1) concentrations at 36 weeks’ gestation and low birthweight, an indicator of placental insufficiency. We generate a 4-tier risk model based on SPINT1 concentrations, where the highest risk tier has approximately a 2-5 fold risk of birthing neonates with birthweights under the 3rd, 5th, 10th and 20th centiles, whereas the lowest risk tier has a 0-0.3 fold risk. Low SPINT1 is associated with antenatal ultrasound and neonatal anthropomorphic indicators of placental insufficiency. We validate the association between low circulating SPINT1 and placental insufficiency in two other cohorts. Low circulating SPINT1 is a marker of placental insufficiency and may identify pregnancies with an elevated risk of stillbirth.


Funder: RANZCOG Research Foundation (RANZCOG); doi:

Funder: The Stillbirth Foundation

Funder: Tommy's; doi:

Funder: National Institute Health Research Manchester Academic Health Science Centre

Funder: RCUK | Biotechnology and Biological Sciences Research Council (BBSRC); doi:

Funder: Centre for Trophoblast Research


Article, /692/53, /692/699, /38, /82/80, /38/88, article

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Nature Communications

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Nature Publishing Group UK
Department of Health | National Health and Medical Research Council (NHMRC) (1105603, 1065854, 1136418, 1183854)