Angiogenic factor abnormalities and risk of peripartum complications and prematurity among urban predominantly obese parturients with chronic hypertension

Heimberger, Sarah; Mueller, Ariel; Ratnaparkhi, Rubina; Perdigao, Joana Lopes; Rana, Sarosh

doi:10.1016/j.preghy.2020.04.004

Cited by 18 publications

(19 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As in this study, low PlGF or high sFlt‐1/PlGF ratio has been associated with PE in both white and non‐white women 22,23 . Our study showed that in black and South Asian (versus white) women, serum PlGF is 47 and 13% higher, respectively, and the sFlt‐1/PlGF ratio 20 and 14% lower.…”

Section: Discussionsupporting

confidence: 75%

Effect of race on the measurement of angiogenic factors for prediction and diagnosis of pre‐eclampsia

Wright

Dadelszen

Magee

et al. 2022

BJOG

View full text Add to dashboard Cite

Objective To examine the effect of self‐declared race on serum placental growth factor (PlGF) and sFlt‐1/PlGF ratio and the impact on pre‐eclampsia (PE) prediction. Design Prospective observational study. Setting Two UK maternity hospitals. Population 29 035 women with singleton pregnancies attending a routine 35+0 to 36+6 weeks' gestation hospital visit, including 654 (2.3%) who subsequently developed PE. Methods The predictive performance of PlGF and sFlt‐1/PlGF for PE in minority racial groups (versus white) was examined. Main outcome measure Delivery with PE. Results Compared with white women, mean PlGF was higher and sFlt‐1/PlGF ratio lower in black, South Asian, East Asian and mixed race women. In white women at a PlGF concentration cut‐off corresponding to a screen‐positive rate (SPR) of 10%, detection rates (DRs) were 49.1% for PE at any time and 72.3% for PE within 2 weeks after screening. In black women, at the same PlGF concentration cut‐off for white women, the SPR was 5.5%, and DRs 33.6% and 55.0%, respectively; the number of PE cases was too small to evaluate screening performance in other racial groups. Using a fixed cut‐off in sFlt‐1/PlGF ratio to identify women at risk of developing PE, similarly diagnostically disadvantaged black women. Bias was overcome by adjusting metabolite concentrations for maternal characteristics and use of the competing risks model to estimate patient‐specific risks. Conclusion Screening for PE with fixed cut‐offs in PlGF or sFlt‐1/PlGF diagnostically disadvantages black women. It is essential that measured levels of PlGF be adjusted for race as well as other maternal characteristics.

show abstract

Section: Discussionsupporting

confidence: 75%

Effect of race on the measurement of angiogenic factors for prediction and diagnosis of pre‐eclampsia

Wright

Dadelszen

Magee

et al. 2022

BJOG

View full text Add to dashboard Cite

show abstract

“…A possible explanation might be the above-mentioned “low BMI” study cohorts. Nevertheless, obese women affected by AMO, APO or PE show elevated levels of sFlt-1/PIGF compared to obese women without further complications [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

Performance of sFlt-1/PIGF Ratio for the Prediction of Perinatal Outcome in Obese Pre-Eclamptic Women

Karge

Desing

Haller

et al. 2022

JCM

View full text Add to dashboard Cite

Obese women are at high risk of developing pre-eclampsia (PE). As an altered angiogenic profile is characteristic for PE, measurement of soluble fms-like tyrosine kinase-1 (sFlt-1)/placental growth factor (PIGF) ratio in the maternal serum can be helpful for PE diagnosis, as well as for adverse perinatal outcome (APO) prediction. There is growing evidence that obesity might influence the level of sFlt-1/PIGF and, therefore, the aim of the study was the evaluation of sFlt-1/PIGF as an APO predictor in obese women with PE. Pre-eclamptic women who had an sFlt-1/PIGF measurement at the time of diagnosis were retrospectively included. Women were classified according to their pre-pregnancy body mass index (BMI) as normal weight (BMI < 25 kg/m2), overweight (BMI > 25–29.9 kg/m2) or obese (BMI ≥ 30 kg/m2). APO was defined as the occurrence of one of the following outcomes: Small for gestational age, defined as a birthweight < 3rd centile, neonatal mortality, neonatal seizures, admission to neonatal unit required (NICU) or respiratory support. A total of 141 women were included. Of them, 28 (20%) patients were obese. ROC (receiver operating characteristic) analysis revealed a high predictive value for sFlt-1/PIGF and APO across the whole study cohort (AUC = 0.880, 95% CI: 0.826–0.936; p < 0.001). However, the subgroup of obese women showed a significantly lower level of sFlt-1 and, therefore, the performance of sFlt-1/PIGF as APO predictor was poorer compared to normal or overweight PE women (AUC = 0.754, 95% CI: 0.552–0.956, p = 0.025). In contrast to normal or overweight women, a ratio of sFlt-1/PIGF < 38 could not rule out APO in women with obesity.

show abstract

“…Women who developed PP-HTN also showed a trend toward higher ratio of sFLT1/PIGF than those without postpartum HTN, consistent with prior studies indicating that higher sFLT1/PlGF levels are associated with higher risk of adverse maternal outcomes. 21,22 sFLT1 has been shown in vitro to induce vasoconstriction and endothelial dysfunction, and induces a syndrome resembling preeclampsia in rats. 29 sFLT1 levels rise during the third trimester of all pregnancies but are markedly elevated in pregnancies complicated by preeclampsia.…”

Section: Discussionmentioning

confidence: 99%

“…33 An imbalance in anti-and pro-angiogenic factors, or elevated sFLT1/PlGF ratio, is thought to contribute to endothelial dysfunction, preeclampsia pathogenesis, and adverse maternal outcomes. 21,22 Therefore, sFLT1 and PlGF appear to play an important pathophysiologic role in the development of preeclampsia, and in the subsequent increased prevalence of PP-HTN and cardiovascular dysfunction. ASA has been shown in vitro to reduce hypoxia-induced sFLT1 production.…”

Section: Discussionmentioning

confidence: 99%

Prenatal Low-Dose Aspirin Use Associated with Reduced Incidence of Postpartum Hypertension among Women with Preeclampsia

et al. 2021

View full text Add to dashboard Cite

Objective Postpartum hypertension (PP-HTN), defined as systolic/diastolic blood pressure (SBP/DBP) ≥140/90, on two occasions at least 4 hours apart after delivery occurs in up to 50% of preeclamptic pregnancies, and is associated with adverse maternal outcomes. Excessive production of antiangiogenic factors (i.e., soluble fms-like tyrosine kinase 1 [sFLT1]) and reduced levels of proangiogenic factors (i.e., placental growth factor [PlGF]) are associated with preeclamptic pregnancies. The aim of this study was to identify clinical risk factors and/or serum biomarkers associated with PP-HTN in preeclampsia. Study Design Preeclamptic women (n = 82, aged ≥18 years) were prospectively enrolled in an observational study. Serial blood pressures were obtained through the labor course and until 48 hours postpartum, and serum was obtained within 24 hours postpartum. Statistical analysis was performed by using Student's two-tailed t-test and Fisher's exact test. Results Baseline comorbidities and antihypertensive use were similar among those who developed PP-HTN and those who did not. Among preeclamptic patients, 33% developed PP-HTN; these had significantly more severe preeclampsia features versus no PP-HTN (96 vs. 78%, p = 0.05). PP-HTN was associated with higher re-hospitalization rates (26 vs. 6%, p = 0.01). Among those taking low-dose aspirin (ASA) for preeclampsia prophylaxis (n = 12), PP-HTN was significantly less frequent versus those not taking low-dose ASA (0 vs. 22%, p = 0.007). Low-dose ASA use was associated with significantly lower peripartum sFLT1 levels (4,650 ± 2,335 vs. 7,870 ± 6,282 pg/mL, p = 0.03) and sFLT1/PlGF ratio (397 ± 196 vs. 1,527 ± 2,668, p = 0.03). Conclusion One-third of women with preeclampsia develop PP-HTN; these patients have more severe preeclampsia and have higher re-hospitalization rates. Prenatal low-dose ASA use was associated with significantly lower incidence of PP-HTN, reduced levels of antiangiogenic factors, and lower 6-week re-hospitalization rates. These findings, if replicated, may have clinical implications on the use of low-dose ASA during pregnancy to reduce incidence of postpartum HTN. Key Points

show abstract

Angiogenic factor abnormalities and risk of peripartum complications and prematurity among urban predominantly obese parturients with chronic hypertension

Cited by 18 publications

References 24 publications

Effect of race on the measurement of angiogenic factors for prediction and diagnosis of pre‐eclampsia

Effect of race on the measurement of angiogenic factors for prediction and diagnosis of pre‐eclampsia

Performance of sFlt-1/PIGF Ratio for the Prediction of Perinatal Outcome in Obese Pre-Eclamptic Women

Prenatal Low-Dose Aspirin Use Associated with Reduced Incidence of Postpartum Hypertension among Women with Preeclampsia

Contact Info

Product

Resources

About