Placental Growth Factor (PlGF) in Women with Suspected Pre-Eclampsia Prior to 35 Weeks’ Gestation: A Budget Impact Analysis

Duckworth, Suzy; Chappell, Lucy C; Seed, Paul; Mackillop, Lucy; Shennan, Andrew; Hunter, Rachael

doi:10.1371/journal.pone.0164276

Cited by 23 publications

(17 citation statements)

References 14 publications

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“…Hemodynamic‐guided antihypertensive therapy for pregnant women presenting with any type of hypertension significantly reduced the rates of severe maternal hypertension from 18% to 3.5%, when compared with standard care 30. Early detection and characterization of hypertensive disorders of pregnancy should also be investigated from a cost‐savings perspective, as maternal cardiovascular and circulating protein information could impact decision making and disease trajectory 31, 32. From a feasibility perspective, commercial non‐invasive hemodynamic monitoring systems are now available for the convenient and safe monitoring maternal hemodynamics in pregnant women.…”

Section: Discussionmentioning

confidence: 99%

Phenotypes of Pregnant Women Who Subsequently Develop Hypertension in Pregnancy

McLaughlin

Zhang

Lye

et al. 2018

JAHA

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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.

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Section: Discussionmentioning

confidence: 99%

Phenotypes of Pregnant Women Who Subsequently Develop Hypertension in Pregnancy

McLaughlin

Zhang

Lye

et al. 2018

JAHA

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“…Duckworth and colleagues estimated that inclusion of PlGF in a clinical algorithm for suspected PE could save a mean of UK£582 (€654) per woman tested, via reduced resource use . The algorithm categorizes patients into care levels according to BP and a PlGF cutoff (traffic light) system.…”

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

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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.

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“…However, the use of angiogenic factors in high‐risk populations (women who present with signs or symptoms of PE) may confer significant economic benefit . Various studies have suggested savings using the sFlt‐1/PlGF ratio of £334/patient (UK), £945/patient (UK); €670/patient (Italy), and using PlGF alone of £35 087/1000 patients (UK) …”

Section: Economic Modelling/potential Economic Impactmentioning

confidence: 99%

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

Cerdeira

Agrawal

Staff

et al. 2017

BJOG

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Pre‐eclampsia is a complex disease with significant maternal and fetal morbidity and mortality. Its syndromic nature makes diagnosis and management difficult. The field is rapidly evolving with the definition of pre‐eclampsia being challenged by some organisations, with proteinuria no longer being essential in the presence of other features. In the last decade, angiogenic factors, in particular soluble fms‐like tyrosine kinase 1 (sFlt‐1), have emerged as important molecules in the pathogenesis of pre‐eclampsia. Here we review the most recent evidence regarding the potential of these factors as biomarkers and therapeutic targets for pre‐eclampsia.Tweetable abstractA review of angiogenic factors, sFlt‐1 and PlGF, in the diagnosis, prediction and management of pre‐eclampsia.

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Placental Growth Factor (PlGF) in Women with Suspected Pre-Eclampsia Prior to 35 Weeks’ Gestation: A Budget Impact Analysis

Cited by 23 publications

References 14 publications

Phenotypes of Pregnant Women Who Subsequently Develop Hypertension in Pregnancy

Phenotypes of Pregnant Women Who Subsequently Develop Hypertension in Pregnancy

The role of angiogenic factors in the management of preeclampsia

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

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