26: The soluble form of the receptor for advanced glycation end-products (sRAGE), a decoy for rage, is increased in the serum level of women with severe preeclampsia

Abstract

FETAL DEMISE SAROSH RANA, ALEJANDRO RAUH-HAIN, ANANTH KARUMANCHI, RAVI THADHANI, Brown University / Women & Infants’ Hospital of Rhode Island, Obstetrics and Gynecology, Providence, Rhode Island, Massachusetts General Hospital, Medicine, Boston, Massachusetts, Beth Israel Deaconess Medical Center and Harvard Medical School, Departments of Medicine/Obstetrics and Gynecology, Boston, Massachusetts, Massachusetts General Hospital and Harvard Medical School, Medicine, Boston, Massachusetts OBJECTIVE: The purpose of this study was to determine whether increased maternal serum levels of soluble fms-like tyrosine kinase -1 (sFlt-1) and decreased levels of placental growth factor (PlGF) measured during the first trimester are associated with a subsequent increased risk of intrauterine fetal demise (IUFD). STUDY DESIGN: We performed a prospective, nested case-control study of the Massachusetts General Hospital Obstetric Maternal Study (MOMS). This cohort included 34 cases of IUFD, as well as 246 randomly selected control women who delivered a healthy baby at term. First-trimester serum samples were assayed for circulating levels of sFlt-1 and PlGF by ELISA. We used logistic regression to assess the risk of IUFD according to baseline levels of angiogenic factors and to adjust for potential confounders. RESULTS: Women with IUFD had significantly increased first-trimester levels of sFlt-1 (1178 / 530 vs. 889 / 562 pg/ml; p 0.01) but there were no significant differences in PlGF levels according to pregnancy outcome (38.6 / 20.8 vs. 40.0 / 28.4 pg/ml; p NS). In the unadjusted analysis, there was a 7% increase in risk of IUFD (RR 1.07; 95% CI 1.011.14; p 0.02) with each 100 pg/ml increase in sFlt-1. There was no association between PlGF and IUFD. When sFlt-1 was analyzed according to tertiles based on women in the control group, the highest tertile (OR 9.59; 95% CI 1.92 48.0; p 0.01) was associated with a markedly increased risk of IUFD compared to the lowest tertile. CONCLUSION: Increased maternal serum levels of sFlt-1 measured in the first trimester are independently associated with increased risk of IUFD.