AB0547 PLACENTAL ANGIOGENESIS MARKERS IN THE SCREENING FOR ADVERSE PREGNANCY OUTCOMES IN SLE AND APS

Abstract

BackgroundPregnancies in patients with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) are at risk for adverse pregnancy outcomes such as preeclampsia or placental insufficiency and prematurity. In these high-risk pregnancies, maternal serum concentration of the anti-angiogenic factor soluble Fms-like tyrosine kinase-1 (sFlt-1) and the pro-angiogenic factor placental growth factor (PlGF) can predict fetal growth restriction and preeclampsia (1-3).ObjectivesTo evaluate the sFlt-1/PlGF ratio in routine assessment of singleton high-risk pregnancies in patients with SLE and APS.MethodsPatients with SLE and APS that followed in our outpatient clinic were retrospectively analysed for their pregnancy course and outcomes. In these high-risk pregnancies, the sFlt-1/PlGF ratio was measured in the context of screening for preeclampsia and a ratio below 38 was applied to exclude preeclampsia. We compared the sFlT-1/PlGF ratio between patients with and without adverse pregnancy outcome. Adverse pregnancy outcome (APO) was defined as preeclampsia, preterm delivery and small for gestational age newborns.ResultsWe analysed sFlt-1/PlGF ratios of 13 singleton pregnancies in 12 patients with SLE and/or APS (4 SLE, 6 SLE with APS or aPL, 2 obstetric APS). Low-dose aspirin was used in all but one pregnancy with de-novo obstetric APS. Low-molecular weight heparin was given in seven pregnancies. Adverse pregnancy outcome occurred in five pregnancies thereof two with preeclampsia. The median sFlt-1/PlGF ratio measured between gestational week 22 and 37 was higher in patients with APO (median 173, range 4 -1904) than in patients without APO (median 7.5, range 1-50) (P=0.03). The sFlt-1/PlGF ratio > 38 was found in 6 pregnancies including two with preeclampsia. Highest sFlt-1/PlGF ratios were found in a case with severe intrauterine growth restriction without signs of preeclampsia (sFlt-1/PlGF=1940) and in a case with early preeclampsia < week 34 (sFlt-1/PlGF=1187). In pregnancies with a sFlt-1/PlGF ratio < 38 there were no signs of preeclampsia or intrauterine growth restriction.ConclusionThe detection of a dysbalanced sFlt-1/PlGF ratio is clinically useful as it differentiates between pregnancies with adverse outcome and those without. More data are needed to further evaluate the predictive potential of these placental biomarkers in the first trimester and their usefulness for treatment adjustments in order to improve pregnancy outcome.