Premium
Longitudinal changes in maternal serum placental growth factor and soluble fms‐like tyrosine kinase‐1 in women at increased risk of pre‐eclampsia
Author(s) -
Khalil A.,
Maiz N.,
GarciaMandujano R.,
Penco J. M.,
Nicolaides K. H.
Publication year - 2016
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.15750
Subject(s) - medicine , gestation , soluble fms like tyrosine kinase 1 , gestational age , placental growth factor , gestational hypertension , eclampsia , pregnancy , preeclampsia , prospective cohort study , obstetrics , risk factor , endocrinology , vascular endothelial growth factor , biology , genetics , vegf receptors
Objectives To investigate longitudinal changes in maternal serum levels of placental growth factor ( PlGF ) and soluble fms‐like tyrosine kinase‐1 ( sFlt ‐1) in pregnant women who develop pre‐eclampsia ( PE ) or gestational hypertension ( GH ). Methods This was a prospective longitudinal study in women with singleton pregnancies identified by screening at 11 + 0 to 13 + 6 weeks' gestation as being at high‐risk of PE . Blood samples were taken every 4 weeks until delivery. Values were compared in women who developed preterm PE (requiring delivery before 37 weeks' gestation), term PE or GH and those who remained normotensive. Results A total of 1069 samples were analyzed in 234 women, including 172 who remained normotensive, 18 who developed GH , 22 who developed preterm PE and 22 who developed term PE . In the preterm PE group, compared to the normotensive group, sFlt ‐1 levels were significantly higher from 15 weeks' gestation onward and the difference increased with gestational age ( P < 0.001). In the preterm PE group, compared to the normotensive group, PlGF levels were significantly lower from 11 weeks' gestation onward and the difference increased significantly with gestational age ( P < 0.001). Similarly, in the term PE and GH groups, PlGF levels were lower from 13 and 27 weeks onward, respectively, and the differences increased significantly with gestational age ( P < 0.001 for both groups). In the preterm PE group, compared to the normotensive group, the sFlt ‐1/ PlGF ratio was significantly higher from 11 weeks onward and the difference increased significantly with gestational age ( P < 0.001). A random slope model provided a significantly better fit to the data than did a single‐level model for sFlt ‐1 (likelihood ratio ( LR ) = 516; degrees of freedom (df) = 3; P < 0.001), PlGF ( LR = 542; df = 3; P < 0.001) and the sFlt ‐1/ PlGF ratio ( LR = 468; df = 3; P < 0.001). Conclusion Repeat measurements of the biochemical markers used in this study are likely to be better predictors of PE than are measurements at a single time point during pregnancy, as the differences between normotensive and hypertensive pregnancies increase with gestational age. In screening for preterm PE , maternal serum level of PlGF is a useful marker from the first trimester onward, while the level of sFlt ‐1 is likely to have a predictive value from the second trimester onward. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.