Diagnostic Performance of Placental Growth Factor in Women With Suspected Preeclampsia Attending Antenatal Facilities in Maputo, Mozambique

Abstract

C omplicating an estimated 3% to 10% of pregnancies, the hypertensive disorders of pregnancy account for an estimated 46,000 maternal and 500,000 perinatal deaths annually, with >99% of these deaths occurring in less-developed countries, including Mozambique.1,2 The most dangerous of the hypertensive disorders of pregnancy is preeclampsia, the origins of which lie in a mixture of maternal and placental factors.3,4 Currently, delivery is the only mechanism by which to initiate the resolution of preeclampsia, 3 whether that delivery is spontaneous or iatrogenic. Iatrogenic delivery is predicated on a timely diagnosis of preeclampsia, with additional safeguards being offered through avoidance of, and response to, severe maternal hypertension and eclampsia for women and risks of prematurity for fetuses before term. 1The diagnosis of the hypertensive disorders of pregnancy, especially preeclampsia, largely remains reliant on women having access to accurate blood pressure (BP) measurement, estimation of urinary protein, and testing for end organ complications. Women in their community and admitted to hospital with a hypertensive disorders of pregnancy can be assessed for actuarial risk using either the demographics-, symptom-, and sign-based miniPIERS (Pre-Eclampsia Integrated Estimate of Risk) tool, especially when supplemented by pulse oximetry 5,6 or the demographics-, symptom-, sign-, and laboratory testbased fullPIERS tool. 7In well-resourced settings, low concentrations of circulating maternal-free placental growth factor (PlGF) (sometimes relative to soluble fms-like tyrosine kinase-1) or antiangiogenic See Editorial Commentary, pp 401-403Abstract-In well-resourced settings, reduced circulating maternal-free placental growth factor (PlGF) aids in either predicting or confirming the diagnosis of preeclampsia, fetal growth restriction, stillbirth, preterm birth, and delivery within 14 days of testing when preeclampsia is suspected. This blinded, prospective cohort study of maternal plasma PlGF in women with suspected preeclampsia was conducted in antenatal clinics in Maputo, Mozambique. The primary outcome was the clinic-to-delivery interval. Other outcomes included: confirmed diagnosis of preeclampsia, transfer to higher care, mode of delivery, intrauterine fetal death, preterm birth, and low birth weight. Of 696 women, 95 (13.6%) and 601 (86.4%) women had either low (<100 pg/mL) or normal (≥100 pg/mL) plasma PlGF, respectively. The clinicto-delivery interval was shorter in low PlGF, compared with normal PlGF, women (median 24 days [interquartile range, 10-49] versus 44 , P=0.0042). Also, low PlGF was associated with a confirmed diagnosis of preeclampsia, higher blood pressure, transfer for higher care, earlier gestational age delivery, delivery within 7 and 14 days, preterm birth, cesarean delivery, lower birth weight, and perinatal loss. In urban Mozambican women with symptoms or signs suggestive of preeclampsia, low maternal plasma PlGF concentrations are associated with increased risks of adverse pregnancy o...

Early diagnosis of preeclampsia using placental growth factor: An operational pilot study in Maputo, Mozambique

“…The low rate of use of antenatal corticosteroids (0•7%) in this cohort of women is consistent with the findings in our previous Maputo-based study (8) We have identified that introducing PlGF into clinical care in antenatal clinics is associated with increased identification of women who are deemed to require transfer to higher levels of care.…”

“…In this implementation study, we have determined that among women with preeclampsia who attended prenatal clinics in Maputo, Mozambique, the introduction of a package of care, including the use of PlGF, was associated with both an increased detection of preeclampsia and an increased number of transfers of care. In addition, low maternal plasma PlGF identified women destined to deliver soon and have more complicated pregnancies, as determined previously using masked PlGF results (8). Also, we have determined that maternal plasma PlGF <40 -50 pg/ml identifies a group of women at exceptionally high risk for suffering an intrauterine fetal death (32•6% of women with PlGF <50 pg/ml).…”

“…Previously, we have confirmed the diagnostic performance of masked plasma PlGF in identifying women at increased risk of imminent delivery in clinics in Maputo, Mozambique (8); through the identification of pregnancy complications beyond preeclampsia, such as fetal growth restriction of placental origin (9). Therefore, we have proposed that PlGF should improve the provision of precision medicine to individual women and improve pregnancy outcomes for those with preeclampsia or related placenta-mediated complications in all settings.…”

Angiogenic factors: potential to change clinical practice in pre‐eclampsia?

“…A wide external validation in other populations would be desirable. Currently, substantial data are being generated worldwide, including in low‐income countries, which will hopefully help to address this matter …”

165. Improved prediction of gestational hypertension by inclusion of placental growth factor and Pregnancy Associated Plasma Protein-A in a sample of Ghanaian women

“…Ukah et al in a prospective cohort study of pregnant women attending antenatal care in Maputo, Mozambique, measured the serum PlGF concentration in women suspected of having preeclampsia after 20 weeks of gestation. This study had as its primary outcome, the time-to-delivery after confirmation of preeclampsia [36]. This study differed from ours in terms of being a diagnostic study rather than a prediction study.…”