Do the physiological aging of the placenta and the changes in angiogenesis marker sFlt-1 and PlGF concentrations predispose patients to late-onset preeclampsia?

Abstract

(1) Analyses of disordered angiogenesis markers in early- and late-onset preeclampsia patients and patients with physiological pregnancies allow for a suggestion that natural "ageing of the placenta" and placental hypoperfusion lesions exacerbating with the advancing gestational age are some of the causes of late-onset preeclampsia. (2) Cases of early-onset preeclampsia are associated with more severe changes of disordered angiogenesis marker concentrations, which may be indicative of a more considerable impairment of placental perfusion in such patients. (3) In the course of the physiological pregnancy, there is a gradual increase in sFlt-1 and decrease in PlGF, which implies an elevated angiogenesis disorder that progresses with the gestational age.

ELABELA plasma concentrations are increased in women with late-onset preeclampsia

“…Preeclampsia can be subdivided into early-onset (<34 weeks of gestation) and late-onset (>34 weeks of gestation) variants [82,83,84], of which the latter is the most frequent [85,86,87]. The pathophysiology observed between early-and late-onset preeclampsia is different: in late-onset preeclampsia, the angiogenic/anti-angiogenic imbalance is milder than in the early-onset variant [62,65,70,88,89,90,91,92,93,94]. Indeed, such factors [placental growth factor (PlGF), soluble vascular endothelial growth factor receptor-1 (or soluble fms-like tyrosine kinase-1, sFLT1), soluble endoglin] and their ratios are considered biomarkers for the detection of early-onset preeclampsia [62,63,71,86,88,89,95,96,97,98,99].…”

Hypertensive Disorders of Pregnancy and Fetal Growth Restriction: Clinical Characteristics and Placental Lesions and Possible Preventive Nutritional Targets

“…This finding appears late in pregnancy [10]. The delayed occurrence of villous maturation might be related to a hypoxic-oxidative environment that manifests late in pregnancy, likely when placental growth reaches its functional limits [40]. However, the severity of these late maldevelopments is not enough to produce high values of sFlt-1/PlGF ratio, a marker of oxidative stress.…”

Prediction of preeclampsia developing at term

“…By contrast, in term-PE the placental contribution seems less important, UTPI is often normal and there is usually normal fetal growth [10][11][12][13]. Rather, it seems that for term-PE, a maternal threshold for "tolerance" to the burden of pregnancy is achieved and that maternal characteristics such as being obese, having metabolic syndrome, comorbid conditions or insulin resistance are more likely to play a role [14][15][16][17].…”