857: Angiogenic factors and prediction for ischemic placental disease in future pregnancies

Abstract

Conditions of ischemic placental disease (IPD), including preeclampsia, abruption, and intrauterine growth restriction, often recur in subsequent pregnancies. Angiogenic factors have been associated with adverse outcomes in the concurrent pregnancy, but have not been studied as predictors of pregnancy outcomes in subsequent pregnancies. We hypothesized that elevated angiogenic factors in an index pregnancy would be associated with a recurrence of IPD. We conducted a retrospective cohort study of singleton pregnant patients who had angiogenic factors measured in an index pregnancy and experienced a subsequent pregnancy at the same institution. Patients with IPD in the index pregnancy were included. An elevated ratio of soluble fms-like tyrosine kinase 1 (sFlt1) and placental growth factor (PlGF) was defined as greater than or equal to 85. The primary outcome was IPD in a subsequent pregnancy, which was a composite of preeclampsia, abruption, small for gestational age (SGA), and intrauterine fetal demise. Secondary outcomes included the components of IPD with severe SGA. Data are presented as median (interquartile range) or proportion, and log-binomial regression was used to estimate risk ratios (RR) and 95% confidence intervals (CI). We included 90 patients in the analysis. The sFlt1/P1GF ratio was elevated in 29% of participants. Those with an elevated ratio were more likely to be nulliparous (88% vs. 71%) in the index pregnancy, and less likely to have chronic hypertension (0% vs. 6%). Overall, the recurrence of IPD in the study was 28%, with a non-significant difference in risk based on a high sFlt-1/P1GF ratio RR 0.47 (95% CI 0.18-1.2) compared to a low ratio. Similarly, we did not find an association between a high ratio and any of the components of IPD. A high sFlt1/P1GF ratio in an index pregnancy is not associated with a higher risk of IPD in a subsequent pregnancy and does not improve on risk prediction noted in prior studies. This study is limited overall by a small sample size and may reflect selection bias of a healthier population.View Large Image Figure ViewerDownload Hi-res image Download (PPT)