Placental Growth Factor as a Prognostic Tool in Women With Hypertensive Disorders of Pregnancy

Ukah, Ugochinyere Vivian; Hutcheon, Jennifer A.; Payne, Beth; Haslam, Matthew D.; Vatish, Manu; Ansermino, J. Mark; Brown, Helen; Magee, Laura A.; Dadelszen, Peter von

doi:10.1161/hypertensionaha.117.10150

Cited by 34 publications

(30 citation statements)

References 44 publications

(92 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Notably, PlGF seemed to have relatively poor predictive potential for late‐onset disease (sensitivity: 45%), likely rooted in a lesser role for defective placentation in late‐onset pathogenesis . In 2017, Ukah et al published results from a systematic review of studies that investigated the potential for PlGF to predict maternal and fetal complications in hypertensive disorders of pregnancy . They found that PlGF was useful for predicting fetal complications (including preterm delivery and adverse neonatal outcomes), with AUC of ≥0.70, although PlGF did not produce a clinically significant improvement in the prediction of adverse maternal outcomes.…”

Section: Predictive Tests Utilizing Angiogenic Factorsmentioning

confidence: 99%

The role of angiogenic factors in the management of preeclampsia

Flint

Cerdeira

Redman

et al. 2019

Acta Obstet Gynecol Scand

Self Cite

View full text Add to dashboard Cite

Preeclampsia is a pregnancy disorder causing substantial maternal and fetal morbidity and mortality. In the UK, its diagnosis currently depends upon new onset hypertension and proteinuria. There is a clinical need for enhanced screening to prevent unnecessary resource use and improve outcomes. Here, the current practice in preeclampsia diagnosis will be summarized, with assessment of the evidence that angiogenic factors could improve its management. Although the combination of new onset hypertension and proteinuria define and hence diagnose the disorder, separately they are poorly predictive. Preeclampsia is ultimately a placental disease caused by syncytiotrophoblast dysfunction. The angiogenic factors placental growth factor, soluble fms‐like tyrosine kinase 1 and soluble endoglin, all originating at least in part from the syncytiotrophoblast, are biomarkers with predictive potential for preeclampsia and related adverse outcomes. Recent work with the soluble fms‐like tyrosine kinase 1/placental growth factor ratio has identified key measurement cutoffs, with one having a high negative predictive value for preeclampsia. The soluble fms‐like tyrosine kinase 1/placental growth factor ratio seems particularly promising as a screening measure, able to predict accurately the short‐term absence of preeclampsia and suggest the likelihood of adverse events within 4 weeks. The ratio could be used to allocate specific management plans to patients according to risk. An understanding of angiogenic factors may also lead to new therapeutic options for a condition currently only curable by delivery, although it must be remembered that the factors are markers of underlying syncytiotrophoblast stress, which would not be resolved by targeting them.

show abstract

Section: Predictive Tests Utilizing Angiogenic Factorsmentioning

confidence: 99%

The role of angiogenic factors in the management of preeclampsia

Flint

Cerdeira

Redman

et al. 2019

Acta Obstet Gynecol Scand

Self Cite

View full text Add to dashboard Cite

show abstract

“…Importantly, the natural history in terms of risks for mother and fetus are also highly variable, and the ability to predict these risks is an important priority. Consequently, the obstetric and cardiology communities have made joint calls to try and effectively utilize prognostic indicators as a strategy to identify, classify and guide treatment for hypertensive disorders of pregnancy 6, 7, 8. To effectively translate current knowledge and develop effective pathway‐specific therapeutic strategies, the predictive value of clinical characteristics, maternal hemodynamic and placental indicators must be evaluated.…”

Section: Introductionmentioning

confidence: 99%

Phenotypes of Pregnant Women Who Subsequently Develop Hypertension in Pregnancy

McLaughlin

Zhang

Lye

et al. 2018

JAHA

View full text Add to dashboard Cite

BackgroundHypertensive disorders complicating pregnancy are a major cause of maternal death. Our objective was to evaluate maternal clinical, hemodynamic, and placental prognostic indicators in a consolidated manner to identify women who develop hypertension in pregnancy.Methods and ResultsTwenty‐six normotensive pregnant women from a specialized Placenta Clinic at increased risk of developing de novo hypertension and 20 normotensive healthy pregnant controls were recruited at 22 to 26 weeks' gestation. Fourteen maternal clinical, hemodynamic, and placental characteristics were assessed in the second trimester and aggregated. Principal component analysis of this combined data set determined that 3 dimensions accounted for 56% of the cohort variability. The first dimension accounted for 31% of the cohort variability, with significant contributions from total peripheral resistance, endoglin, and cardiac output. The second dimension was predominantly influenced by body mass index and mean arterial pressure, while uric acid and myeloperoxidase mainly contributed to the third dimension. Unsupervised clustering identified 3 groups within this combined data set. Total peripheral resistance was the most significant distinguishing parameter between these groups (P<0.0001), followed by placental growth factor, endoglin, and cardiac output (P<0.0001). Using these 4 parameters, a receiver operating curve was constructed with an area under the curve of 0.975 (95% confidence interval 0.93–1) for the prediction of developing hypertension in pregnancy.ConclusionsConsolidated assessment of prognostic indicators in the second trimester of pregnancy may be useful to characterize and distinguish pathways by which women may develop hypertension in pregnancy. This approach could contribute to the development of pathway‐specific preventative and antihypertensive treatment strategies.

show abstract

“…cessation of PlGF synthesis(20,(48)(49)(50). In the setting of hypertensive disorders of pregnancy, a recent review by Ukah et al demonstrated that lower PlGF levels were predictive of poorer neonatal outcomes and preterm birth(1). Recent literature also suggests that a similar hypoxic process secondary to suboptimal placental function and reflected by lower levels of maternal PlGF may also be present later in pregnancy causing late-onset FGR and intrapartum fetal compromise culminating in adverse neonatal outcomes(8,13,44).…”

mentioning

confidence: 99%

Systematic review of maternal Placental Growth Factor levels in late pregnancy as a predictor of adverse intrapartum and perinatal outcomes

Sherrell

Dunn

Clifton

et al. 2018

European Journal of Obstetrics & Gynecology and Reproductiv

View full text Add to dashboard Cite

Low maternal PlGF levels in late pregnancy are strongly associated with SGA. Findings across studies were variable in relation to PlGF and the prediction of other adverse intrapartum and perinatal outcomes, however there was a consistent association between low PlGF levels and CS for fetal compromise, NICU admission and stillbirth. This review suggests that the use of PlGF for the prediction of adverse outcomes is promising. Its predictive value may potentially be enhanced if used in combination with other biomarkers or biophysical measures of fetal well-being.

show abstract

Placental Growth Factor as a Prognostic Tool in Women With Hypertensive Disorders of Pregnancy

Abstract: Supplemental Digital Content is available in the text.

Cited by 34 publications

References 44 publications

The role of angiogenic factors in the management of preeclampsia

The role of angiogenic factors in the management of preeclampsia

Phenotypes of Pregnant Women Who Subsequently Develop Hypertension in Pregnancy

Systematic review of maternal Placental Growth Factor levels in late pregnancy as a predictor of adverse intrapartum and perinatal outcomes

Contact Info

Product

Resources

About