Prediction Of Preeclampsia In Women Research Articles

The sFLT-1/PlGF Ratio for the Prediction of Preeclampsia-Related Adverse Fetal and Maternal Outcomes in Women with Preexisting Diabetes.

To evaluate the predictive value of the sFlt-1/PlGF ratio for the prediction of preeclampsia in women with preexisting diabetes mellitus. This is a monocentric retrospective observational study conducted between January 2018 and December 2020. All singleton pregnancies with preexisting diabetes mellitus, who had a dosage of the sFlt-1/PlGF ratio between 30 and 34 + 6 weeks of gestation were included. The principal outcome was preeclampsia. The secondary outcomes were preterm preeclampsia, gestational hypertension, placental abruption, intrauterine fetal death, IUGR, small for gestational age and a composite outcome named "hypertensive disorder of pregnancy" including gestational hypertension, preeclampsia and HELLP syndrome (hemolysis, elevated liver enzymes and low platelet count). Of 63 patients, 22% presented preeclampsia. The area under the curve of sFlt-1/PlGF ratio was 0.90 (95% CI: 0.79-0.96) for the prediction of preeclampsia. The receiver operator characteristic analysis suggested that the optimal sFlt-1/PlGF cutoff to predict preeclampsia was 29, with a sensitivity of 86% (95% CI: 60.1-96.0) and a specificity of 92% (95% CI: 80.8-96.8). A cut-off of 38 provided a sensitivity of 71% (95% CI: 45.4-88.3), a specificity of 92% (95% CI: 80.8-96.8). Further analysis using multivariable methods revealed nephropathy was significantly associated with PE (p = 0.014). The use of the sFlt-1/PlGF ratio during the third trimester of pregnancy seems to be of interest as a prognostic tool to improve multidisciplinary management of patients with preexisting diabetes mellitus.

Biomarkers for Early Prediction and Management of Preeclampsia: A Comprehensive Review.

Preeclampsia is a common complication of pregnancy. It is a multi-organ disorder that remains one of the main causes of maternal morbidity and mortality. Additionally, preeclampsia leads to many complications that can occur in the fetus or newborn. Preeclampsia occurs in about 1 in 20 pregnant women. This review focuses on the prediction of preeclampsia in women, using various biomarkers, in particular, a factor combining the use of soluble FMS-like tyrosinokinase-1 (sFlt-1) and placental growth factor (PlGF). A low value of the sFlt-1/PlGF ratio rules out the occurrence of preeclampsia within 4 weeks of the test result, and its high value predicts the occurrence of preeclampsia within even 1 week. The review also highlights other factors, such as pregnancy-associated plasma protein A, placental protein 13, disintegrin and metalloprotease 12, ß-human chorionic gonadotropin, inhibin-A, soluble endoglin, nitric oxide, and growth differentiation factor 15. Biomarker testing offers reliable and cost-effective screening methods for early detection, prognosis, and monitoring of preeclampsia. Early diagnosis in groups of women at high risk for preeclampsia allows for quick intervention, preventing the undesirable effects of preeclampsia. However, further research is needed to validate and optimize the use of biomarkers for more accurate prediction and diagnosis. This article aims to review the role of biomarkers, including the sFlt1/PlGF ratio, in the prognosis and management of preeclampsia.

Statement of Retraction: First versus second trimester mean platelet volume and uric acid for prediction of preeclampsia in women at moderate and low risk

Statement of Retraction: First versus second trimester mean platelet volume and uric acid for prediction of preeclampsia in women at moderate and low risk

Prediction and prevention of preeclampsia in women with preexisting diabetes: the role of home blood pressure, physical activity, and aspirin.

Women with type 1 or type 2 (preexisting) diabetes are four times more likely to develop preeclampsia compared with women without diabetes. Preeclampsia affects 9%-20% of pregnant women with type 1 diabetes and 7%-14% of pregnant women with type 2 diabetes. The aim of this narrative review is to investigate the role of blood pressure (BP) monitoring, physical activity, and prophylactic aspirin to reduce the prevalence of preeclampsia and to improve pregnancy outcome in women with preexisting diabetes. Home BP and office BP in early pregnancy are positively associated with development of preeclampsia, and home BP and office BP are comparable for the prediction of preeclampsia in women with preexisting diabetes. However, home BP is lower than office BP, and the difference is greater with increasing office BP. Daily physical activity is recommended during pregnancy, and limiting sedentary behavior may be beneficial to prevent preeclampsia. White coat hypertension in early pregnancy is not a clinically benign condition but is associated with an elevated risk of developing preeclampsia. This renders the current strategy of leaving white coat hypertension untreated debatable. A beneficial preventive effect of initiating low-dose aspirin (150 mg/day) for all in early pregnancy has not been demonstrated in women with preexisting diabetes.

Home Blood Pressure for the Prediction of Preeclampsia in Women With Preexisting Diabetes.

Outside of pregnancy, home blood pressure (BP) has been shown to be superior to office BP for predicting cardiovascular outcomes. This work aimed to evaluate home BP as a predictor of preeclampsia in comparison with office BP in pregnant women with preexisting diabetes. A prospective cohort study was conducted of 404 pregnant women with preexisting diabetes; home BP and office BP were measured in early (9 weeks) and late pregnancy (35 weeks). Discriminative performance of home BP and office BP for prediction of preeclampsia was assessed by area under the receiver operating characteristic curves (AUC). In total 12% (n = 49/404) developed preeclampsia. Both home BP and office BP in early pregnancy were positively associated with the development of preeclampsia (adjusted odds ratio (95% CI) per 5 mm Hg, systolic/diastolic): home BP 1.43 (1.21-1.70)/1.74 (1.34-2.25) and office BP 1.22 (1.06-1.40)/1.52 (1.23-1.87). The discriminative performance for prediction of preeclampsia was similar for early-pregnancy home BP and office BP (systolic, AUC 69.3 [61.3-77.2] vs 64.1 [55.5-72.8]; P = .21 and diastolic, AUC 68.6 [60.2-77.0] vs 66.6 [58.2-75.1]; P = .64). Similar results were seen when comparing AUCs in late pregnancy (n = 304). In early and late pregnancy home BP was lower than office BP (early pregnancy P < .0001 and late pregnancy P < .01 for both systolic and diastolic BP), and the difference was greater with increasing office BP. In women with preexisting diabetes, home BP and office BP were positively associated with the development of preeclampsia, and for the prediction of preeclampsia home BP and office BP were comparable.

Prediction of preeclampsia based on maternal serum endoglin level in women with pregestational diabetes mellitus

ABSTRACT Purpose To evaluate the level of soluble endoglin (sEng) in pregnant women with pregestational diabetes mellitus (DM) and to assess its predictive value for preeclampsia development. Methods Ninety pregnant women were enrolled in the study forming five comparison groups: type 1 DM (not planned, n = 20; planned, n = 20), type 2 DM (diet, n = 15; insulin therapy, n = 20), and the control group (n = 15). The primary outcome was clinically confirmed preeclampsia. Maternal serum concentrations of sEng were measured at 11+0–13+6 and 30+0–33+6 weeks. Results sEng level was elevated in all patients with pregestational DM compared to the control group. Its plasma concentration increased with gestational age and in case of preeclampsia development. In patients with type 1 DM, serum sEng level did not depend on the presence of preeclampsia. This is evidence of severe metabolic disorder and endothelial dysfunction in these patients. The addition of sEng level to logistic models considering established risk factors (body mass index + age + HbA1c level) in the first and third trimesters significantly improved their performance for preeclampsia prediction. Conclusions Eng level may become an important marker for early prediction of preeclampsia in women with pregestational DM.

Angiogenic factors and the risk of preeclampsia: A systematic review and meta-analysis.

BackgroundThe etiological nature of preeclampsia is heterogeneous. The use of biomarkers indices in early pregnancy helps to have appropriate stratification of pregnancies into high- and low risk for the purpose of choosing timely interventions.ObjectiveThe aim of this systematic review was to determine the pathogenic role of soluble soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) in the prediction of preeclampsia in women.Materials and MethodsWe performed a systematic search of the international databases including PubMed, Scopus, and Web of Science until August 2017. The quality of included studies was assessed using the Newcastle-Ottawa Scale. The primary outcome in this review was preeclampsia. The statistical heterogeneity was assessed using the X test and quantified by I. Pooled effects size was obtained by random effects model. Subgroup analyses were also carried out.ResultsTotally, 284 records were identified in the initial search and 15 records were finally included in the meta-analysis. The pooled odds ratios (ORs) for the association between the high level of sFlt-1 and low level of PlGF and subsequent development of preeclampsia among women were 5.20 (95% CI: 1.24–9.16) and 2.53 (95% CI: 1.33–3.75), respectively. The mean difference for sFlt-1 and PlGF in women with preeclampsia compared to controls was 1.15 (95% CI: 0.43–1.86) and –0.94 (95% CI: –1.37–0.52), respectively.Conclusion According to the results from this meta-analysis, increased levels of sFlt-1 and reduced levels of PlGF predict the subsequent development of preeclampsia.

First versus second trimester mean platelet volume and uric acid for prediction of preeclampsia in women at moderate and low risk

ABSTRACT Objective: To determine if second trimester mean platelet volume (MPV) and serum uric acid are reasonable predictors of preeclampsia (PE) or not, in patients at moderate and low risk. Methods: This prospective study was conducted on 9522 women at low or moderate risk for developing PE who underwent dual measurements of MPV and serum uric acid at late first trimester (10–12 weeks) and at second trimester (18–20 weeks) and subsequently divided into two groups; PE group (n = 286) who later developed PE and non-PE group (n = 9236). Test validity of MPV and serum uric acid was the primary outcome measure. Data were collected and analyzed. Results: Second trimester MPV is a good predictor for development of PE at a cutoff value of 9.55 fL with area under the curve (AUC) of 0.86, sensitivity of 95.2%, specificity of 66.7%, positive predictive value (PPV) of 87%, negative predictive value (NPV) of 85.7%, and accuracy of 86.7%. Second trimester serum uric acid is a good predictor for development of PE at a cutoff value of 7.35 mg/dL, with AUC of 0.85, sensitivity of 95.2%, specificity of 55.6%, PPV of 83.3%, NPV of 83.3%, and accuracy of 83.3%. Combination of both tests has a sensitivity of 100%, specificity of 22.2%, PPV of 75%, NPV of 100%, and accuracy of 76.7%. Conclusion: Second trimester MPV and serum uric acid alone or in combination could be used as a useful biochemical markers for prediction of PE based on their validity, simplicity, and availability.

OP 3 Assessment of the added value of early pregnancy 24-h ambulatory blood pressure monitoring for the prediction of pre-eclampsia in women with chronic hypertension

Introduction Whilst pre-eclampsia (PE) is highly prevalent amongst women with chronic hypertension, early identification of women at the highest risk is currently not possible. In this study we sought to explore the added value of ambulatory blood pressure monitoring (ABPM) for the prediction of pre-eclampsia. Methods We performed a prospective exploratory study. Women were recruited (⩽20 weeks) from the Manchester Antenatal Vascular Services (MAViS) research clinic and fitted with a Spacelabs monitor. Blood pressure (BP) readings were not revealed to the woman during the monitoring period. The BP was recorded every 30 min during the day (08:00–22:00 h) and hourly at night (22:00–08:00 h). Drug ingestion time, sleep and wake periods were self-reported [JM1]. Parameters calculated from the exported readings included: average daytime and night-time BP, maximum daytime and nighttime BP. Multivariable logistic regression was performed using AUC and likelihood ratio testing to compare model fit. Results 79 women underwent 24-h ABPM of whom 19 (25%) women developed PE. Age ( p = 0.11), BMI and clinic visit BP (136.3 ± 12.8 vs 133.0 ± 16.7 and 86.8 ± 8.7 vs 88.3 ± 12.0) were not different between the groups; PE was more common in women of non-white ethnicity ( p Conclusion Despite equivalent clinic BPs, ABPM parameters demonstrated modest prediction for PE, particularly measurements obtained overnight. On going work is continuing to explore the association between BP variability and PE to fully assess the added value of ABPM in high-risk pregnancies.

Budget impact analysis of sFlt-1/PlGF ratio as prediction test in Italian women with suspected preeclampsia

Introduction: Preeclampsia (PE) is a pregnancy disease which represents a leading cause of maternal and perinatal mortality and morbidity. Accurate prediction of PE risk could provide an increase in health benefits and better patient management.Objective: To estimate the economic impact of introducing Elecsys sFlt-1/PlGF ratio test, in addition to standard practice, for the prediction of PE in women with suspected PE in the Italian National Health Service (INHS).Methods: A decision tree model has been developed to simulate the progression of a cohort of pregnant women from the first presentation of clinical suspicion of PE in the second and third trimesters until delivery. The model provides an estimation of the financial impact of introducing sFlt-1/PlGF versus standard practice. Clinical inputs have been derived from PROGNOSIS study and from literature review, and validated by National Clinical Experts. Resources and unit costs have been obtained from Italian-specific sources.Results: Healthcare costs associated with the management of a pregnant woman with clinical suspicion of PE equal €2384 when following standard practice versus €1714 using sFlt-1/PlGF ratio test.Conclusions: Introduction of sFlt-1/PlGF into hospital practice is cost-saving. Savings are generated primarily through improvement in diagnostic accuracy and reduction in unnecessary hospitalization for women before PE’s onset.

O113. Measurements of arterial stiffness and uterine artery Doppler for the prediction of preeclampsia in women presenting with gestational hypertension

Objective While gestational hypertension (GH) and chronic hypertension are usually benign, pre-eclampsia (PE) is more commonly associated with adverse maternal and fetal outcomes. About 15–25% of women initially diagnosed with GH will develop PE, but only 10% of women who develop GH after 36 weeks of gestation will develop PE. Pulse wave velocity (PWV) and augmentation index (AIx) are markers of arterial stiffness and endothelial dysfunction, while uterine artery Doppler pulsatility index (UtA PI) reflects the resistance in the uteroplacental circulation. These parameters have been shown to be associated with the risk of PE. The main aim of this study was to investigate whether maternal cardiovascular changes can discriminate pregnancies which will subsequently develop PE among those presenting with GH. Methods This was a prospective cohort study in women with singleton pregnancies presenting with GH at St George’s Hospital (n = 112). Another group of uncomplicated singleton pregnancies were recruited as controls. PWV, AIx and aortic systolic blood pressure (SBPAo) were recorded using the Arteriograph® (TensionMed Ltd., Budapest, Hungary). The uterine artery Doppler was recorded on both sides and the mean PI was calculated. Mann-Whitney and Chi-Square tests were used to compare the groups, while regression analysis was used to identify and adjust for potential confounders. The predictive accuracy for the development of PE was assessed using the ROC curve analysis. Results The analysis included 105 pregnancies with GH and 356 controls. Compared to the group that remained as GH (n = 82), the group that developed PE (n = 23) had significantly higher AIx (25.9%, IQR 12.8–34.3 vs 15.8%, IQR 6.1–25.6; p = 0.019) and SBPAo (141 mmHg, IQR 130–158 vs 130 mmHg, IQR 123–142; p = 0.005) at the initial assessment. They also had significantly higher UtA mean PI at 20–24 weeks (1.10, IQR 0.78–1.47 vs 0.83, IQR 0.68–1.04; p = 0.008). AIx was significantly associated with the risk of development of PE (odds ratio 1.05; 95% CI 1.01–1.09, p = 0.016). For a cut-off of 31.18%, AIx had sensitivity of 41.2% (95% CI 18.4–67.1%) and specificity of 93.2% (95% CI 83.5–98.1%) and LR 6.07 (AUC 0.69; 95% CI 0.53–0.84, p = 0.019). Conclusion Arterial stiffness and SBPAo measured at the initial assessment of GH can potentially discriminate the pregnancies that will develop PE. Identification of women who will develop PE among those who initially present with PIH is likely to facilitate targeted antenatal surveillance and possibly intervention.

O23. STEPS (Study of Early Preeclampsia in Spain): sFlt-1/PlGF for the prediction of early-onset preeclampsia in singleton pregnancies

Introduction The soluble fms-like tyrosine kinase 1 (sFlt-1)/placental growth factor (PlGF) ratio is CE-mark approved for short-term prediction of preeclampsia in women with clinical suspicion of the syndrome (gestational age 24weeks+0d–36weeks+6d). Objectives We evaluated sFlt-1/PlGF as a predictive marker for early-onset preeclampsia in women at high risk of preeclampsia. Methods STEPS (prospective/multicenter) included pregnant women with preeclampsia risk factors (including history of IUGR/preeclampsia/eclampsia/HELLP syndrome, pre-gestational diabetes, antiphospholipid antibodies, and abnormal uterine artery Doppler). Primary objective: to show that sFlt-1/PlGF was predictive of early-onset preeclampsia ( ® sFlt-1 and PlGF assays, cobas electrochemiluminescence platform, Roche Diagnostics, Germany); bilateral uterine artery Doppler; blood pressure/proteinuria/preeclampsia status assessment. Results were compared by ANOVA/Dunnet and Wilcoxon signed-rank test. For prediction of early-onset preeclampsia, the area under the curve (AUC) of receiver operating characteristic curves (ROC) was calculated. Singleton pregnancies are reported. Results 819 subjects were enrolled. Of 442 women with singleton pregnancies 42 (9.5%) developed preeclampsia (14 early-onset/28 late-onset). The mean (SD) sFlt-1/PlGF ratio at 20, 24, and 28 weeks was: 7.86 (8.61), 5.9 (12.38) and 4.59 (5.65) for subjects who did not develop preeclampsia (control); 53.15 (61.79), 69.25 (105.53) and 180.37 (241.83) for early-onset preeclampsia; and 7.81 (4.45), 5.09 (3.34) and 13.39 (34.52) for late-onset preeclampsia. Compared with early-onset preeclampsia the sFlt-1/PlGF ratio was significantly lower for control, chronic hypertension, transient hypertension, and late-onset preeclampsia (Figure). Prediction of early-onset preeclampsia (ROC AUC [95% CI]) was best for sFlt-1/PlGF plus clinical data (0.94 [0.90–0.98], 0.94 [0.89–1.0], 0.94 [0.86–1.0], at 20, 24 and 28 weeks) vs sFlt-1/PlGF alone (0.78 [0.62–0.95], 0.82 [0.65–0.98], 0.86 [0.72–1.0]) or Doppler alone (0.71 [0.56–0.86], 0.73 [0.54–0.91], 0.87 [0.74–1.0]). Conclusion The sFlt-1/PlGF ratio can improve prediction of early-onset preeclampsia for women at high risk of preeclampsia.

The Role of Angiogenic and Antiangiogenic Factors in the Second Trimester in the Prediction of Preeclampsia in Pregnant Women With Type 1 Diabetes

OBJECTIVETo assess the association between circulating angiogenic and antiangiogenic factors in the second trimester and risk of preeclampsia in women with type 1 diabetes.RESEARCH DESIGN AND METHODSMaternal plasma concentrations of placental growth factor (PlGF), soluble fms-like tyrosine kinase 1 (sFlt-1), and soluble endoglin (sEng) were available at 26 weeks of gestation in 540 women with type 1 diabetes enrolled in the Diabetes and Preeclampsia Intervention Trial.RESULTSPreeclampsia developed in 17% of pregnancies (n = 94). At 26 weeks of gestation, women in whom preeclampsia developed later had significantly lower PlGF (median [interquartile range]: 231 pg/mL [120–423] vs. 365 pg/mL [237–582]; P < 0.001), higher sFlt-1 (1,522 pg/mL [1,108–3,393] vs. 1,193 pg/mL [844–1,630] P < 0.001), and higher sEng (6.2 ng/mL [4.9–7.9] vs. 5.1 ng/mL[(4.3–6.2]; P < 0.001) compared with women who did not have preeclampsia. In addition, the ratio of PlGF to sEng was significantly lower (40 [17–71] vs. 71 [44–114]; P < 0.001) and the ratio of sFlt-1 to PlGF was significantly higher (6.3 [3.4–15.7] vs. 3.1 [1.8–5.8]; P < 0.001) in women who later developed preeclampsia. The addition of the ratio of PlGF to sEng or the ratio of sFlt-1 to PlGF to a logistic model containing established risk factors (area under the curve [AUC], 0.813) significantly improved the predictive value (AUC, 0.850 and 0.846, respectively; P < 0.01) and significantly improved reclassification according to the integrated discrimination improvement index (IDI) (IDI scores 0.086 and 0.065, respectively; P < 0.001).CONCLUSIONSThese data suggest that angiogenic and antiangiogenic factors measured during the second trimester are predictive of preeclampsia in women with type 1 diabetes. The addition of the ratio of PlGF to sEng or the ratio of sFlt-1 to PlGF to established clinical risk factors significantly improves the prediction of preeclampsia in women with type 1 diabetes.

PP051. Prediction of preeclampsia with the sFlt-1/PLGF ratio: impact of the slope of repeated measurements

Patients with preeclampsia (PE) exhibit different serum concentrations of sFlt-1 and PlGF. The sFlt-1/PlGF ratio can be used as an aid in the diagnosis of preeclampsia. The objective of this study was to explore the use of the sFlt-1/PlGF ratio as an aid in the prediction of preeclampsia in women with a high risk of the condition. 150 patients with high risk of preeclampsia were included in this prospective study. Groups were compared according to the outcome of pregnancy: healthy pregnant women (controls, n=114), pregnancies complicated by intrauterine growth restriction without PE (IUGR, n=14), early PE<34 weeks of gestation (early PE, n=6) and late PE⩾34 weeks of gestation (late PE, n=16). Measurements of sFlt-1 and PlGF were performed on the automated Elecsys system. Statistical comparison of the sFlt-1/PlGF ratio in different outcome groups and multilevel analysis for logistic data using the random slope model was performed. We found significant differences in the sFlt-1/PlGF ratio between the outcome groups in weeks 24-36 of gestation (p=0,05). A significant difference in the sFlt-1/PlGF ratio between controls, IUGR and PE (early and late PE) could be measured up to six weeks before diagnosis (PE) or birth (IUGR, controls) (p=0,05). The random slope model showed significant different slopes (p=0,05) for individual outcome groups (controls 0,657; IUGR 1,786; early PE 1,951; late PE 0,881). The sFlt-1/PlGF ratio is able to identify pathologic pregnancy outcomes in gestational weeks 24-36. Prediction is feasible up to six weeks before clinical diagnosis (PE) or 6 weeks before birth (IUGR, controls). Repeated measurements are necessary beginning in 24 weeks of gestation with a maximum distance of six weeks. The slope between two measurements of the sFlt-1/PlGF ratio is predictive of further pregnancy outcome and the risk of developing preeclampsia.

First‐trimester markers for the prediction of pre‐eclampsia in women with a‐priori high risk

To investigate the predictive value of the combination of first-trimester serum placental protein 13 (PP13), uterine artery Doppler pulsatility index (PI) and pulse wave analysis (augmentation index at a heart rate of 75 beats per min (AIx-75)), and to evaluate concurrent and contingent strategies using this combination for assessing the risk of pre-eclampsia in high-risk women. In this nested case-control study, serum PP13, uterine artery mean PI and AIx-75 were measured at between 11 + 0 and 13 + 6 weeks' gestation in women at increased risk of pre-eclampsia. For each case of pre-eclampsia (n = 42), five matched controls were randomly selected from the study group. Gestation specific multiples of the median (MoMs) were adjusted for body mass index, ethnicity, smoking, age and parity. MoMs were compared between cases and controls using the Wilcoxon rank sum test. Sensitivities and specificities were derived from receiver-operating characteristics curves. Compared with controls, women who developed pre-eclampsia had lower PP13, higher uterine artery mean PI and higher AIx-75 (P < 0.001). For a 10% false-positive rate, the best detection rate for pre-eclampsia (85.7% (95% CI, 71.5-94.6%)) and pre-eclampsia requiring delivery before 34 weeks (92.9% (95% CI, 66.1-99.8%)) was achieved by concurrent testing with all three markers. The best contingency screening sequences for pre-eclampsia were (AIx-75 --> PP13 --> mean PI) and (PP13 --> AIx-75 --> mean PI), with an 86% detection rate for false-positive rates of 9 and 10%, respectively. These two sequences would require 410 and 414 tests, respectively, compared with 756 tests in concurrent testing. Combination of first-trimester PP13, uterine artery mean PI and pulse-wave analysis is promising for the prediction of pre-eclampsia in women at increased a-priori risk and may be useful in clinical practice. Contingency screening achieved similar detection rates to concurrent testing, but required almost 50% fewer tests, making it a more cost-effective option.

OP08.09: Concurrent and contingency strategies using first trimester markers for the prediction of pre-eclampsia in women with a priori high risk

OP08.09: Concurrent and contingency strategies using first trimester markers for the prediction of pre-eclampsia in women with a priori high risk

Angiogenic factors for the prediction of pre-eclampsia in women with abnormal midtrimester uterine artery Doppler velocimetry

Objective To determine whether assessing uterine perfusion and angiogenic factors concurrently in the second trimester improves the prediction of pre-eclampsia and intrauterine growth restriction (IUGR). Method Plasma levels of soluble fms-like tyrosine kinase 1 (sFlt-1) and placental growth factor (PlGF) were measured for 108 women with abnormal uterine perfusion on Doppler velocimetry in the 23rd week. Later, 33 cases of pre-eclampsia and 9 of IUGR developed. Results Compared with the plasma levels of the women whose pregnancies remained normal, sFlt-1 levels were significantly higher and PlGF levels significantly lower in the women whose pregnancies became complicated by pre-eclampsia and/or IUGR ( P < 0.001). The alterations were more pronounced in cases of early-onset pre-eclampsia and in cases of IUGR that necessitated delivery before 34 weeks. Using the sFlt-1/PlGF ratio, these complications could be predicted with 98% sensitivity, 95% specificity, and 93% positive predictive value. Conclusion Measuring uterine perfusion and angiogenic factors concurrently in the second trimester improved the prediction of pre-eclampsia and IUGR.

Homocysteine plasma concentration levels for the prediction of preeclampsia in women with chronic hypertension

OBJECTIVE: The purpose of this study was to evaluate prospectively midtrimester homocysteine concentration levels for the prediction of superimposed preeclampsia in women with chronic hypertension. STUDY DESIGN: Between March 1, 2000, and February 1, 2002, pregnancies that were complicated by chronic hypertension that required medication had homocysteine, vitamin B 12, and folate concentrations measured between 16 and 20 weeks of gestation. All women received folate supplementation. An upper limit threshold for increased homocysteine was defined as the mean value plus 2 SDs. RESULTS: Fifty-seven women were enrolled. Mean homocysteine concentration levels were 5.1±1.7 μmo/L for the 16 women who had preeclampsia compared with 4.7±1.3 μmo/L for the 41 women without preeclampsia ( P = .56). Two of 16 women with preeclampsia (13%) had concentration levels that exceeded the 95th percentile (6.9 μmo/L) compared with 2 of 41 women (5%) without preeclampsia ( P = .31). The sensitivity and specificity were 13% (95% CI, 1.6-38.3) and 95.1% (95% CI, 83.5-99.4), respectively. CONCLUSION: Second-trimester homocysteine concentration levels were not helpful in the prediction of preeclampsia in chronically hypertensive women.

Poor predictive value of platelet count, mean platelet volume and serum urate in hypertension in pregnancy

Objective: To determine the usefulness of platelet count, mean platelet volume and serum uric acid levels in the prediction of pre-eclampsia in women with mild hypertension in pregnancy, and to see if it is appropriate to base the management of such patients on these tests. Subjects: Three hundred and thirty-six women attending the antenatal day unit with a diagnosis of non-proteinuric hypertension in pregnancy (diastolic blood pressure ≥ 90 mmHg on two separate recordings) from whom at least one blood sample was taken. Main outcomes measured: The development of proteinuria (1+ or greater on urine Albustix); the need for oral antihypertensive medication, the need for the ‘pre-eclampsia regime’ intra- or post-partum; the need for induction of labour because of hypertension. Results: No test, at any cut-off level, was found to be of any use in predicting the outcomes studied. Nor was a weekly change in any of the tests found to be of any use. Conclusion: Basing the management of patients with mild non-proteinuric hypertension on the results of platelet count, mean platelet volume or urate level is unwise as none of these tests was able to predict outcome in such patients.