Predictive and prognostic significance of placental growth factor in pregnant women at high-risk for development of preeclampsia

Jyoti Meena; Soniya Dhiman; Archana Singh; Perumal Vanamail; Seema Singhal

doi:10.18203/2320-1770.ijrcog20232944

Authors

Jyoti Meena Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
Soniya Dhiman Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
Archana Singh Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
Perumal Vanamail Department of Biostatistics, Trichy SRM Medical College Hospital and Research Centre, Trichy, Tamil Nadu, India
Seema Singhal Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20232944

Keywords:

Placental growth factor, Preeclampsia, Preterm birth, Fetal growth restriction, Adverse obstetrical outcomes

Abstract

Background: The study aimed to assess the predictive and prognostic role of placental growth factor (PlGF) in high-risk antenatal women for development of preeclampsia (PE).

Methods: In this observational cohort study, antenatal women with gestation age from 20 to 32 weeks with high risk for development of PE were included. Serum PlGF was estimated by sandwich ELISA technique. A p-value of less than .05 was considered significant.

Results: A total of 286 high-risk women were analysed for development of PE and obstetric outcomes. Of these 97/286 (34%) developed PE and 62/286 (21.7%) had abnormal PlGF value ( 100 pg/ml). Among the women with abnormal PIGF, 48 (77.4%) developed PE and out of 224 women with normal PIGF level, 49 (21.9%) developed PE resulting in a significant (p<0.001) odds ratio of 12.2 (95% CI: 6.0-25.9). For prediction of PE, a sensitivity and specificity of more than 75% at a cut-off value of <204.5 pg/ml was observed by ROC curve analysis. For prediction of preterm delivery (<34 weeks), a sensitivity and specificity of 65% was observed at a cut-off value of PlGF 191.7 pg/ml. Obstetric complications like eclampsia, preterm births (<34 weeks), neonate with low 5-minute APGAR score, low birth weight, fetal growth restriction, still-births and neonatal intensive care unit admissions all were significantly higher in abnormal PlGF group compared with normal PlGF group (p<0.05).

Conclusions: Serum PlGF levels can provide valuable information for the prediction of PE and preterm births and abnormal PlGF values showed a significant association with adverse obstetrical outcomes.

Metrics

Metrics Loading ...

References

Hutcheon JA, Lisonkova S, Joseph KS. Epidemiology of pre-eclampsia and the other hypertensive disorders of pregnancy. Best Pract Res Clin Obstet Gynaecol. 2011;25(4):391-403.

Meh C, Sharma A, Ram U, Fadel S, Correa N, Snelgrove JW, et al. Trends in maternal mortality in India over two decades in nationally representative surveys. BJOG. 2022;129(4):550-61.

Reddy M, Rolnik DL, Harris K, Li W, Mol BW, Da Silva Costa F, et al. Challenging the definition of hypertension in pregnancy: a retrospective cohort study. Am J Obstet Gynecol. 2020;222(6):606.e1-21.

Redman CW, Sargent IL. Latest advances in understanding preeclampsia. Science. 2005; 308(5728):1592-4.

Levine RJ, Maynard SE, Qian C, Lim KH, England LJ, Yu KF, et al. Circulating angiogenic factors and the risk of preeclampsia. N Engl J Med. 2004;350(7):672-83.

Levine RJ, Lam C, Qian C, Yu KF, Maynard SE, Sachs BP, et al. CPEP Study Group. Soluble endoglin and other circulating antiangiogenic factors in preeclampsia. N Engl J Med. 2006;355(10):992-1005.

Rana S, Powe CE, Salahuddin S, Verlohren S, Perschel FH, Levine RJ, et al. Angiogenic factors and the risk of adverse outcomes in women with suspected preeclampsia. Circulation. 2012;125(7):911-9.

Chappell LC, Duckworth S, Seed PT, Griffin M, Myers J, Mackillop L, et al. Diagnostic accuracy of placental growth factor in women with suspected preeclampsia: a prospective multicenter study. Circulation. 2013; 128(19):2121-31.

Zeisler H, Llurba E, Chantraine F, Vatish M, Staff AC, Sennstrom M, et al. Predictive value of the sFlt-1:PlGF ratio in women with suspected preeclampsia. N Engl J Med. 2016;374:13-22.

Griffin M, Seed PT, Duckworth S, North R, Myers J, Mackillop L, et al. Predicting delivery of a small-for-gestational-age infant and adverse perinatal outcome in women with suspected pre-eclampsia. Ultrasound Obstet Gynecol. 2018;51(3):387-95.

Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol. 2013;122(5):1122-31.

Barton JR, Woelkers DA, Newman RB, Combs CA, How HY, Boggess KA, et al. PETRA (Preeclampsia Triage by Rapid Assay) Trial. Placental growth factor predicts time to delivery in women with signs or symptoms of early preterm preeclampsia: a prospective multicenter study. Am J Obstet Gynecol. 2020; 222(3):259.e1-11.

Agrawal S, Shinar S, Cerdeira AS, Redman C, Vatish M. Predictive Performance of PlGF (Placental Growth Factor) for Screening Preeclampsia in Asymptomatic Women: A Systematic Review and Meta-Analysis. Hypertension. 2019;74(5):1124-35.

Varughese B, Bhatla N, Kumar R, Dwivedi SN, Dhingra R. Circulating angiogenic factors in pregnancies complicated by pre-eclampsia. Natl Med J India. 2010;23(2):77-81.

Ghosh SK, Raheja S, Tuli A, Raghunandan C, Agarwal S. Can maternal serum placental growth factor estimation in early second trimester predict the occurrence of early onset preeclampsia and/or early onset intrauterine growth restriction? A prospective cohort study. J Obstet Gynaecol Res. 2013;39(5):881-90.

Ukah UV, Mbofana F, Rocha BM, Loquiha O, Mudenyanga C, Usta M, et al. Diagnostic Performance of Placental Growth Factor in Women With Suspected Preeclampsia Attending Antenatal Facilities in Maputo, Mozambique. Hypertension. 2017;69(3):469-74.

Parchem JG, Brock CO, Chen HY, Kalluri R, Barton JR, Sibai BM; Preeclampsia Triage by Rapid Assay Trial (PETRA) Investigators. Placental Growth Factor and the Risk of Adverse Neonatal and Maternal Outcomes. Obstet Gynecol. 2020;135(3):665-73.

Chappell LC, Duckworth S, Seed PT, Griffin M, Myers J, Mackillop L,et al. Diagnostic accuracy of placental growth factor in women with suspected preeclampsia: a prospective multicenter study. Circulation. 2013;128(19):2121-31.

Duhig KE, Myers J, Seed PT, Sparkes J, Lowe J, Hunter RM, et al. PARROT trial group. Placental growth factor testing to assess women with suspected pre-eclampsia: a multicentre, pragmatic, stepped-wedge cluster-randomised controlled trial. Lancet. 2019;393(10183):1807-18.

Ukah UV, Hutcheon JA, Payne B, Haslam MD, Vatish M, Ansermino JM, et al. Placental Growth Factor as a Prognostic Tool in Women With Hypertensive Disorders of Pregnancy: A Systematic Review. Hypertension. 2017;70(6):1228-37.

Duhig KE, Seed PT, Myers JE, Bahl R, Bambridge G, Barnfield S, et al. Placental growth factor testing for suspected pre-eclampsia: a cost-effectiveness analysis. BJOG. 2019;126(11):1390-8.

Cerdeira AS, O'Sullivan J, Ohuma EO, Harrington D, Szafranski P, Black R, et al. Randomized Interventional Study on Prediction of Preeclampsia/ Eclampsia in Women With Suspected Preeclampsia: INSPIRE. Hypertension. 2019;74(4): 983-90.

Hayes RD, Khashan AS, Hemming K, Easter C, Devane D, Murphy D J et al. Placental growth factor in assessment of women with suspected pre-eclampsia to reduce maternal morbidity: a stepped wedge cluster randomised control trial (PARROT Ireland) BMJ. 2021;374:n1857.