Placental Growth Factor for the Prediction of Adverse Outcomes in Patients with Suspected Preeclampsia or Intrauterine Growth Restriction

Jeanne Sibiude,Olivia Anselem,Raphaël Serreau,Marie-Danielle Dionne,Camille Le Ray,Vassilis Tsatsaris,Jean Guibourdenche,François Goffinet,Cees Oudejans

doi:10.1371/journal.pone.0050208

Abstract

BackgroundThe circulating concentration of PlGF is reported to be lower in patients experiencing preeclampsia and patients delivering a small for gestational age (SGA) neonate. To evaluate the predictive value of circulating PlGF for preeclampsia and adverse outcome in patients with suspected preeclampsia or intrauterine growth restriction (IUGR).Methodology/Principal FindingsA double blind prospective study. We enrolled 96 women for suspected preeclampsia or IUGR, and measured plasma levels of PlGF (Triage®) at enrolment. We defined adverse outcome as severe preeclampsia, SGA neonate (<10th centile) or elective delivery for maternal or fetal complication. Severe adverse outcome was studied among patients included <34 weeks gestation (WG) and defined as eclampsia, HELLP syndrome, very SGA (<3rd centile) or elective delivery <34 WG. The mean logtransformed PlGF level was lower for women who experienced preeclampsia (2.9 vs 3.7, p = 0.02), and was markedly lower for patients who experienced adverse outcome (2.9 vs 4.3, p<0.001). The odds of presenting an adverse outcome were higher for the lowest tertile of PlGF compared to the higher (OR = 13 , 95% CI [3–50]). For severe adverse outcome, odds were respectively for the lowest and intermediate tertile as compared with the higher tertile : OR = 216, 95% CI [18–2571]; and OR = 17, 95% CI [3–94]. When included <34 WG, patients with a PlGF level <12 pg/ml experienced a severe adverse outcome in 96% of cases (24/25), and only 1 of 20 patients with a PlGF level >5th centile experienced a severe adverse outcome within 15 days (5%).Conclusions/SignificanceAmong women with suspected preeclampsia or IUGR, PlGF helps identify women who will experience an adverse outcome and those who will not within a time period of 15 days.

Highlights

Preeclampsia (PE) is a multi-system pregnancy-specific disease, affecting 2 to 8% of all deliveries, with a trend towards an increase in recent years [1,2]
Our main result is that we found an association between placental growth factor (PlGF) concentration used alone and preeclampsia, between decreased PlGF levels and pregnancy adverse outcomes
Changes in PlGF have been described as preceding the outcome by several weeks [24], it has been shown that there is a rapid decrease before appearance of preeclampsia, and that the slope is important for the prediction of adverse outcome [32]

Summary

Introduction

Preeclampsia (PE) is a multi-system pregnancy-specific disease, affecting 2 to 8% of all deliveries, with a trend towards an increase in recent years [1,2]. Our capacity to predict severe maternal and perinatal outcomes remains poor [11,12,13]Several means of pre-clinical diagnosis and prognostic evaluation have been studied, such as Doppler ultrasound examination of umbilical or uterine arteries and biochemical markers (urinary protein, uric acid), with various degrees of predictive accuracy [14,15,16,17]. This suggests that a pre-clinical diagnostic test able to predict maternal and fetal risk could be useful [18,19]. To evaluate the predictive value of circulating PlGF for preeclampsia and adverse outcome in patients with suspected preeclampsia or intrauterine growth restriction (IUGR)

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