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The predictive value of the sFlt ‐1/ PlGF ratio in suspected preeclampsia in a New Zealand population: A prospective cohort study
Author(s) -
Hughes Ruth C.E.,
Phillips Ian,
Florkowski Chris M.,
Gullam Joanna
Publication year - 2023
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/ajo.13549
Subject(s) - medicine , preeclampsia , interquartile range , prospective cohort study , soluble fms like tyrosine kinase 1 , obstetrics , placental growth factor , gestation , population , pregnancy , genetics , environmental health , biology
Background Internationally, placental growth factor (PlGF)‐based tests are used as prognostic markers in suspected preeclampsia. However, Ministry of Health guidelines do not currently endorse PlGF‐based tests in New Zealand (NZ). Aims To investigate the predictive value of soluble fms‐like tyrosine kinase 1 (sFlt‐1)/PlGF ratio in suspected preeclampsia in a NZ population. Materials and Methods A prospective cohort study of singleton pregnancies at 20 +0 –36 +6 weeks gestation with suspected preeclampsia as defined by Society of Obstetric Medicine Australia and NZ (SOMANZ) criteria. Primary objective: to evaluate a sFlt‐1/PlGF ratio >38 at ≤35 +0 weeks gestation to predict birth ≤14 days. Secondary objectives: to assess a sFlt‐1/PlGF ratio cut‐off of 38 at ≤37 +0 weeks gestation, to rule out preeclampsia ≤1 week, rule in preeclampsia ≤4 weeks, and to predict perinatal outcome. Clinicians were blinded to sFlt‐1/PlGF ratio results. Results Included were 222 participants, 19.4% Māori and 10.4% Pasifika. A sFlt‐1/PlGF >38 predicted birth ≤14 days, positive predictive value (PPV) 51.4% (95% CI, 39.6–63.0) and negative predictive value (NPV) 95.9% (95% CI, 91.4–98.1), median (interquartile range) days to birth 14 (2–27) vs 49 (33–70), P < 0.000. A sFlt‐1/PlGF cut‐off of 38 ruled out preeclampsia ≤1 week (NPV 96.2% (95% CI, 92.3–98.2)) and ruled in preeclampsia ≤4 weeks (PPV 75.0% (95% CI, 65.0–82.9)). A sFlt‐1/PlGF >38 was associated with greater perinatal morbidity. Conclusions The predictive value of the sFlt‐1/PlGF ratio in NZ is comparable to that reported in international trials. Used in clinical practice the sFlt‐1/PlGF ratio may aid risk stratification in suspected preeclampsia, directing limited resources to those pregnancies at highest risk.