Angiogenic Factor Estimation as a Warning Sign of Preeclampsia-Related Peripartum Morbidity Among Hospitalized Patients

Perdigao, Joana Lopes; Chinthala, Sireesha; Mueller, Ariel; Minhas, Ruby; Ramadan, Hadi; Naseem, Heba; Young, Danielle; Shahul, Sana; Chan, Siaw Li; Yeo, Kiang-Teck J.; Rana, Sarosh

doi:10.1161/hypertensionaha.118.12205

Cited by 40 publications

(13 citation statements)

References 15 publications

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“…129 The rate of elevation in the antepartum soluble fmslike tyrosine kinase 1/placental growth factor ratio is an independent predictor of hypertension that persists postpartum. 130 Furthermore, preeclampsia-associated endothelial dysfunction and altered cerebrovascular autoregulation have been shown to persist postpartum 131 and may amplify postpartum hypertension risk. Intravenous fluids, mobilization of extravascular fluid, and use of nonsteroidal anti-inflammatory drugs for postpartum analgesia may contribute to its occurrence.…”

Section: Postpartum Hypertension and Postpartum Preeclampsiamentioning

confidence: 99%

Hypertension in Pregnancy: Diagnosis, Blood Pressure Goals, and Pharmacotherapy: A Scientific Statement From the American Heart Association

Garovic¹,

Dechend²,

Easterling³

et al. 2022

Hypertension

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272

174

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Hypertensive disorders of pregnancy (HDP) remain one of the major causes of pregnancy-related maternal and fetal morbidity and mortality worldwide. Affected women are also at increased risk for cardiovascular disease later in life, independently of traditional cardiovascular disease risks. Despite the immediate and long-term cardiovascular disease risks, recommendations for diagnosis and treatment of HDP in the United States have changed little, if at all, over past decades, unlike hypertension guidelines for the general population. The reasons for this approach include the question of benefit from normalization of blood pressure treatment for pregnant women, coupled with theoretical concerns for fetal well-being from a reduction in utero-placental perfusion and in utero exposure to antihypertensive medication. This report is based on a review of current literature and includes normal physiological changes in pregnancy that may affect clinical presentation of HDP; HDP epidemiology and the immediate and long-term sequelae of HDP; the pathophysiology of preeclampsia, an HDP commonly associated with proteinuria and increasingly recognized as a heterogeneous disease with different clinical phenotypes and likely distinct pathological mechanisms; a critical overview of current national and international HDP guidelines; emerging evidence that reducing blood pressure treatment goals in pregnancy may reduce maternal severe hypertension without increasing the risk of pregnancy loss, high-level neonatal care, or overall maternal complications; and the increasingly recognized morbidity associated with postpartum hypertension/preeclampsia. Finally, we discuss the future of research in the field and the pressing need to study socioeconomic and biological factors that may contribute to racial and ethnic maternal health care disparities.

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Section: Postpartum Hypertension and Postpartum Preeclampsiamentioning

confidence: 99%

Hypertension in Pregnancy: Diagnosis, Blood Pressure Goals, and Pharmacotherapy: A Scientific Statement From the American Heart Association

Garovic¹,

Dechend²,

Easterling³

et al. 2022

Hypertension

Self Cite

272

174

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“…Circulating angiogenic factors measured during the third trimester have also been implicated in immediate postpartum hypertension and peripartum morbidity. 207 , 208 Studies using advanced echocardiography have also shown that global longitudinal strain (GLS) with speckle tracking echocardiography is a sensitive measure of the onset of subclinical cardiac dysfunction in PE, and these changes correlate with alterations in circulating sFLT1 and sENG. 209 , 210 Because GLS differentiates active from passive contraction and is less sensitive to loading conditions than ejection fraction, it reliably detects the early onset of subclinical systolic heart failure in patients with PE.…”

Section: Angiogenic Factors and Cardiovascular Diseasementioning

confidence: 99%

Imbalances in circulating angiogenic factors in the pathophysiology of preeclampsia and related disorders

Rana

Burke

Karumanchi

2022

American Journal of Obstetrics and Gynecology

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184

100

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S.R. reports serving as a consultant for Roche Diagnostics and Thermo Fisher Scientific and has received research funding from Roche Diagnostics and Siemens. S.A.K. is colisted as a coinventor on patents related to preeclampsia biomarkers that are held at Beth Israel Deaconess Medical Center. He has financial interests in Aggamin LLC and also reports serving as a consultant for Roche Diagnostics and Thermo Fisher Scientific. S.A.K. has received research funding from Siemens and Thermo Fisher Scientific. S.D.B. reports no conflict of interest.

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“…Підвищення рівня sFlt-1 і зниження PlGF більш різко змінюються при передчасній ПЕ та/або при ПЕ, ускладненій затримкою росту плода [23,24]. У кількох звітах припускають, що ангіогенні фактори, виміряні наприкінці ІІ і ІІІ триместрів, можуть допомогти у діагностиці ПЕ та прогнозуванні несприятливих наслідків із високою чутливістю та специфічністю [25][26][27][28]. Важливо відзначити, що підвищені рівні sFlt-1:PlGF корелювали з ймовірними передчасними пологами, що підтверджено кількома групами [29,30].…”

Section: Methodsunclassified

To the question of the clinical predictive value of the sFlt-1:PlGF ratio is related to the placental dysfunction

Pylypenko

Medved

2022

RHW

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The objective: to evaluate the clinical and prognostic value and meaning of the ratio of the anti-angiogenic factor of soluble fms-like tyrosine kinase-1 (sFlt-1) to the angiogenic factor of the placental growth factor (PlGF) in the dynamics of pregnancy as markers of various variants of placental dysfunction. Materials and methods. A retrospective cohort study of 40 pregnant women, who were distributed by gestation term (up to 34 weeks and after 34 weeks) and the level of sFlt-1:PlGF ratio (<38 is low level, > 110 – high level) was performed. The statistical comparison of the sFlt-1:PlGF ratio with the development of hypertensive disorders during pregnancy and fetal growth retardation (FGR), as well as the duration of the period from research to childbirth was calculated. Results. Preeclampsia (PE) developed in 12 persons out of 40 pregnant women. The sFlt-1:PlGF ratio in the period till 27 weeks of pregnancy in groups of women with PE and without it does not differ with a statistically significant level (p=0.3). In other gestation terms the sFlt-1:PlGF ratio in women with and without placental dysfunction is statistically significant (p<0.05). The sFlt-1:PlGF ratio >38 increases the risk of PE more than 4 times (RR = 4.6) and is statistically significant in a period till 34 weeks [95 % CI: 1.4-14,9]. After 34 weeks of pregnancy the sFlt-1:PlGF ratio >110 has a higher sensitivity (Se=0.75).An analysis of the sFlt-1:PlGF ratio for the purpose of FGR predicting, both in combination with hypertensive disorders during pregnancy or without them, demonstrated its high importance during pregnancy up to 34 weeks (p=0.001). A strong reverse correlation (ƿ= -0.7) was found between the value of the sFlt-1:PlGF ratio and the number of days from the date of research till childbirth at the level of significance of 0.0001 in pregnant women up to 34 weeks. Conclusions. The predictive value of the conventional method of assessing the preeclampsia (PE) risk and the preventive efficiency of acetylsalicylic acid is low. In the absence of clinical manifestation of PE the determination of the sFlt-1:PlGF ratio for a predication till 27 weeks of pregnancy is not informative, so it is not recommended. If the sFlt-1:PlGF ratio is > 38 in the period till 34 weeks, the relative risk is 4.6 [95 % CI: 1.4–14.9]. If the level of the sFlt-1:PlGF ratio is high at first investigation there is no sense to repeat the research in dynamics. In the case of low the sFlt-1:PlGF ratio for a reasonable suspicion of PE development, repeated research can help make an adequate clinical decision. The determination of the sFlt-1:PlGF ratio for a predication or confirmation of fetal growth retardation till 34 weeks is clinically reasonable and informative. There is a strong reverse correlation between the sFlt-1:PlGF ratio and the number of days before the current birth.

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Angiogenic Factor Estimation as a Warning Sign of Preeclampsia-Related Peripartum Morbidity Among Hospitalized Patients

Cited by 40 publications

References 15 publications

Hypertension in Pregnancy: Diagnosis, Blood Pressure Goals, and Pharmacotherapy: A Scientific Statement From the American Heart Association

Hypertension in Pregnancy: Diagnosis, Blood Pressure Goals, and Pharmacotherapy: A Scientific Statement From the American Heart Association

Imbalances in circulating angiogenic factors in the pathophysiology of preeclampsia and related disorders

To the question of the clinical predictive value of the sFlt-1:PlGF ratio is related to the placental dysfunction

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