Placental Growth Factor for the Prediction of Adverse Outcomes in Patients with Suspected Preeclampsia or Intrauterine Growth Restriction

Abstract

BackgroundThe circulating concentration of PlGF is reported to be lower in patients experiencing preeclampsia and patients delivering a small for gestational age (SGA) neonate. To evaluate the predictive value of circulating PlGF for preeclampsia and adverse outcome in patients with suspected preeclampsia or intrauterine growth restriction (IUGR).Methodology/Principal FindingsA double blind prospective study. We enrolled 96 women for suspected preeclampsia or IUGR, and measured plasma levels of PlGF (Triage®) at enrolment. We defined adverse outcome as severe preeclampsia, SGA neonate (<10th centile) or elective delivery for maternal or fetal complication. Severe adverse outcome was studied among patients included <34 weeks gestation (WG) and defined as eclampsia, HELLP syndrome, very SGA (<3rd centile) or elective delivery <34 WG. The mean logtransformed PlGF level was lower for women who experienced preeclampsia (2.9 vs 3.7, p = 0.02), and was markedly lower for patients who experienced adverse outcome (2.9 vs 4.3, p<0.001). The odds of presenting an adverse outcome were higher for the lowest tertile of PlGF compared to the higher (OR = 13 , 95% CI [3–50]). For severe adverse outcome, odds were respectively for the lowest and intermediate tertile as compared with the higher tertile : OR = 216, 95% CI [18–2571]; and OR = 17, 95% CI [3–94]. When included <34 WG, patients with a PlGF level <12 pg/ml experienced a severe adverse outcome in 96% of cases (24/25), and only 1 of 20 patients with a PlGF level >5th centile experienced a severe adverse outcome within 15 days (5%).Conclusions/SignificanceAmong women with suspected preeclampsia or IUGR, PlGF helps identify women who will experience an adverse outcome and those who will not within a time period of 15 days.

Diagnostic Accuracy of Placental Growth Factor in Women With Suspected Preeclampsia

“…We recruited all those who were approached, eligible, and consented but did not document women who declined to take part. Of consented women, 24 did not have a valid baseline sample (17) or were lost to follow-up (7). The characteristics of the remaining 625 women are shown in Table 1, maternal and infant outcomes are in Table 2, details of adverse maternal and perinatal outcomes are in Tables I and II in the online-only Data Supplement, respectively, and unadjusted PlGF concentrations by final diagnosis are shown in Table 3.…”

“…This prospective observational study was undertaken between January 2011 and February 2012 in 7 consultant-led maternity units in the (24) 19 (7) 11 (4) 88 (64) 27 (20) 13 (9) 9 (7) 151 (75) 25 (12) 12 (6) 13 (7) Highest 1st trimester systolic BP, (73) 10 (7) 22 (17) 101 (76) 19 (9) 30 (15) 151 (76) Previous medical history Previous preeclampsia Previous preeclampsia requiring delivery <34/40 55 (20) 30 (11) 17 (12) 6 (4.4)…”

New Developments in the Pathogenesis of Preeclampsia

“…This simple, quantitative, rapid test outperformed the standard battery of clinical diagnostic measures including blood pressure, proteinuria, uric acid, and other laboratory assays 57 . Importantly, sFlt1 and/or PlGF levels at presentation were strongly associated with the remaining duration of pregnancy 53,[57][58][59][60] . We also recently evaluated the role of sEng measurements and found that it has comparable performance to sFlt1/PlGF ratio 61 .…”

Evaluation of serum placental growth factor in predicting pregnancy outcomes in women with suspected pre-eclampsia

“…Serum levels of PLGF are also reduced in the second and third trimesters of pregnancies that develop PE or deliver SGA neonates. 7,[13][14][15][16][17][18][19][20][21][22][23] While the pathophysiology of preeclampsia is not yet fully understood, there is growing evidence associating angiogenic proteins in screening, diagnosing and predicting the clinical course of the condition. 8,10,24,25 Placental growth factor (PLGF) is a proangiogenic marker that circulates at high concentrations in normal pregnancies.…”