Abstract
Objective
To determine maternal serum concentrations of placental growth factor (PlGF) and soluble
fms-like tyrosine kinase-1 (sFlt-1) longitudinally in normal pregnancies, pregnancies
that developed preeclampsia and pregnancies that deliver a small for gestational age
(SGA) infant, in order to evaluate them as markers for the prediction of preeclampsia.
Study design
In this case–control study we included 12 singleton pregnancies that developed preeclampsia
and 104 randomly selected singleton normal pregnancies. Fourteen of the normal pregnancies
gave birth to an SGA infant. Blood samples and ultrasonographic data were collected
during the 1st, 2nd and 3rd trimesters of pregnancy.
Results
In preeclamptic pregnancies, PlGF (pg/mL) (median; inter-quartile range) was significantly
lower in the 2nd (208; 84–339) (p = 0.035) and in the 3rd trimester (202; 109–284) (p = 0.002) while sFlt-1 was significantly higher only in the 3rd trimester (2521; 2101–3041)
(p = 0.011) compared to normal pregnancies (PlGF 2nd: 311; 243–440, PlGF 3rd: 780; 472–1037,
sFlt-1 3rd: 1616; 1186–2220). In pregnancies with SGA infants, PlGF and sFlt-1 did
not differ significantly from normal pregnancies in any trimester. The sFlt-1 to PlGF
ratio was significantly higher in preeclamptic pregnancies than in normal pregnancies,
in both the 2nd and 3rd trimesters. The relative difference and the slope of PlGF
concentration between 1st and 2nd trimester were significantly reduced in preeclampsia
compared to normal pregnancies. A logistic regression model with predictors BMI, 2nd
trimester Doppler PI and relative difference of PlGF from the 1st to the 2nd trimester
gave 46% sensitivity and 99% specificity for the prediction of preeclampsia, with
a very high negative predictive value of 98.3%.
Conclusions
Our study confirms that maternal serum PlGF concentration is significantly lower,
at least after 20th week, while sFlt-1 concentration is significantly higher in 3rd
trimester, in pregnancies destined to develop preeclampsia. Pregnancies that gave
birth to SGA infants do not have altered angiogenic factor concentrations throughout
pregnancy. The relative difference of PlGF from the 1st to the 2nd trimester, uterine
artery Doppler PI in the 2nd trimester and BMI are the most powerful markers for the
prediction of preeclampsia.
Keywords
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Article info
Publication history
Published online: September 09, 2013
Accepted:
August 23,
2013
Received in revised form:
July 24,
2013
Received:
February 18,
2013
Identification
Copyright
© 2013 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
