Circulating Angiogenic Factor Levels in Hypertensive Disorders of Pregnancy

Thadhani, Ravi; Lemoine, Elizabeth R.; Rana, Sarosh; Costantine, Maged M.; Calsavara, Vinícius Fernando; Boggess, Kim; Wylie, Blair J.; Simas, Tiffany A. Moore; Louis, Judette; Espinoza, Jimmy; Gaw, Stephanie L.; Murtha, Amy P.; Wiegand, Samantha; Gollin, Yvonne; Singh, Deepjot; Silver, Robert M.; Durie, Danielle; Panda, Britta; Norwitz, Errol R.; Burd, Irina; Plunkett, Beth A.; Scott, Rachel K.; Gaden, Anna; Bautista, Martha; Chang, Yuchiao; Diniz, Márcio A.; Karumanchi, S. Ananth; Kilpatrick, Sarah J.

doi:10.1056/evidoa2200161

Cited by 47 publications

(57 citation statements)

References 48 publications

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“…A ratio of >38 in patients with suspected preeclampsia and patients diagnosed with preeclampsia without severe features while in triage was predictive of the development of preeclampsia with severe features within 2 weeks of presentation (OR 15.6%, confidence interval 8.91-27.40 for restrictive diagnosis, and OR 14.56% with 95% confidence interval 8.30-25.56 for broader diagnosis) (77). Similarly, another large study assessed the value of sFlt-1/PlGF in predicting progression to preeclampsia with severe features and identifying those at the highest risk of adverse maternal outcomes (78). In patients between gestational ages of 23 and 35 weeks, a ratio of >40 (PPV 65% [95% CI 59,71] and NPV 95% [95% CI 93, 98]) similarly showed an increased risk in progression to severe disease, but also an increased risk in adverse maternal outcomes (78).…”

Section: Major Risk Factorsmentioning

confidence: 99%

“…Similarly, another large study assessed the value of sFlt-1/PlGF in predicting progression to preeclampsia with severe features and identifying those at the highest risk of adverse maternal outcomes (78). In patients between gestational ages of 23 and 35 weeks, a ratio of >40 (PPV 65% [95% CI 59,71] and NPV 95% [95% CI 93, 98]) similarly showed an increased risk in progression to severe disease, but also an increased risk in adverse maternal outcomes (78). Blood pressures alone in the antepartum and intrapartum period have a poor positive predictive value (PPV) for the accurate prediction of adverse outcomes (PPV 18-20% with antepartum and intrapartum blood pressures and 22-36% with antepartum blood pressures alone) (79).…”

Section: Major Risk Factorsmentioning

confidence: 99%

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Preeclampsia pathophysiology and adverse outcomes during pregnancy and postpartum

et al. 2023

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BackgroundPreeclampsia is a disease with far-reaching consequences that extend beyond the immediate postpartum period and have a significant impact later in life. Preeclampsia exerts an effect on most organ systems in the body. These sequelae are mediated in part by the incompletely elucidated pathophysiology of preeclampsia and the associated vascular changes.ContentCurrent research focuses on unraveling the pathophysiology of preeclampsia with the goal of implementing accurate screening and treatment modalities based on disease development and progression. Preeclampsia causes significant short- and long-term maternal morbidity and mortality, not only in the cardiovascular system but also in other organ systems throughout the body. This impact persists beyond pregnancy and the immediate postpartum period.SummaryThe goal of this review is to discuss the current understanding of the pathophysiology of preeclampsia as it relates to the adverse health consequences in patients impacted by this disease, along with a brief discussion of ways to improve overall outcomes.

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Section: Major Risk Factorsmentioning

confidence: 99%

Section: Major Risk Factorsmentioning

confidence: 99%

Preeclampsia pathophysiology and adverse outcomes during pregnancy and postpartum

et al. 2023

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“…Rather, these tests are used as an adjunct to assist the clinician to come to an informed decision. Of note, a broad definition of PE in addition to angiogenic biomarkers best identifies adverse maternal and fetal outcomes [11 ▪▪ ,36 ▪▪ ,42].…”

Section: Novel Diagnostic Approachesmentioning

confidence: 99%

Novel therapeutic and diagnostic approaches for preeclampsia

Vatish

Powys

Cerdeira

2023

Current Opinion in Nephrology &Amp; Hypertension

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Purpose of reviewThis review will summarize recent findings relating to the diagnostic approach to preeclampsia and current avenues of research aimed at modifying the underlying disease process. Recent findingsGrowing international consensus supports a broad preeclampsia definition that incorporates maternal endorgan and uteroplacental dysfunction. Recent evidence demonstrates that this definition better identifies women and babies at risk of adverse outcomes compared to the traditional definition of hypertension and proteinuria. Multiple studies have demonstrated the usefulness and cost-effectiveness of angiogenic biomarkers such as soluble fms-like tyrosine kinase-1 and placental growth factor as a clinical adjunct to diagnose and predict severity of preeclampsia associated outcomes. Current novel therapeutic approaches to preeclampsia target pathogenic pathways (e.g. antiangiogenesis) or downstream effects such as oxidative stress and nitric oxide. Recent findings relating to these promising candidates are discussed. Multicenter clinical trials are needed to evaluate their effectiveness and ability to improve fetal and maternal outcomes.

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“…Similarly, the combination of low maternal plasma PlGF and increased impedance to blood flow in the uterine arteries was used to identify a group of patients at increased risk for early‐onset pre‐eclampsia and/or subsequent development of pre‐eclampsia with severe features 52 . The ratio of sFlt‐1 to PlGF, a metric of angiogenic imbalance, has proved superior to the conventional criteria used to diagnose pre‐eclampsia in the prediction of adverse maternal and neonatal outcomes 53 and the identification of patients who will develop severe features among those admitted to hospital for suspicion of pre‐eclampsia 54 . Additional studies are required to determine if the magnitude of angiogenic imbalance can predict adverse pregnancy outcome when the subjacent insult is uteroplacental malperfusion, regardless of the type of pregnancy complication.…”

Section: Introductionmentioning

confidence: 99%