Placental growth factor predicts time to delivery in women with signs or symptoms of early preterm preeclampsia: a prospective multicenter study

Woelkers, Doug; Newman, Roger B.; Combs, C. Andrew; How, Helen; Boggess, Kim; Martin, James N.; Küpfer, K.; Sibai, Baha M.; Trial, Petra

doi:10.1016/j.ajog.2019.09.003

Cited by 54 publications

(71 citation statements)

References 16 publications

(29 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Several studies have tested the diagnostic ability of PlGF for women with suspected preeclampsia [ 6 , 11 – 13 ]; the PELICAN study reported 96 and 98% sensitivity and negative predictive value, respectively, using PlGF <5th percentile, to predict confirmed preeclampsia and subsequent delivery within 14 days among women presenting with suspected preeclampsia before 35 + 0 weeks of gestation [ 11 ]. Similarly, in a cluster-randomized trial, PlGF < 100 pg/ml identified women (95 and 98% sensitivity and negative predictive value, respectively), with suspected preeclampsia who delivered within 14 days with confirmed pre-eclampsia [ 12 ]; these findings were consistent in the PreEclampsia Triage by Rapid Assay (PETRA) trial with a sensitivity of 92.5% and specificity of 63.8% [ 14 ]. However, fewer studies have aimed to investigate the prognostic value of PlGF in women with confirmed preeclampsia.…”

Section: Introductionmentioning

confidence: 78%

“…In contrast with our study, the PARROT trial reported lower incidence of adverse maternal outcomes in women with suspected preeclampsia (rather than confirmed preeclampsia as studied here), when PlGF values were revealed to the clinician, compared with the concealed group [ 12 ]. However, in the PETRA study [ 14 ] (from which our study extension cohort was derived), clinicians were masked to PlGF values and, therefore, could not have been influenced by the results. Although the PARROT trial results suggest that clinicians might positively respond to low PlGF possibly by increasing surveillance for women potentially at higher risk of adverse outcomes, it did not assess the prognostic value of PlGF for adverse maternal outcomes in women with preeclampsia.…”

Section: Discussionmentioning

confidence: 99%

“…For this study, we used the PETRA data which included women that had PlGF measurements during admission [ 8 , 14 ]. The original data originally consisted of a prospective cohort of 1217 women presenting with suspected symptoms and signs of preeclampsia with measurable PlGF values, at 24 maternity units in the United States of America (USA; N = 23) and Canada ( N = 1) (November 2010 to January 2012) [ 14 ]. Women from the PETRA [ 8 , 14 ] cohort who had confirmed preeclampsia were included in the study.…”

Section: Methodsmentioning

confidence: 99%

“…However, fewer studies have aimed to investigate the prognostic value of PlGF in women with confirmed preeclampsia. In women with suspected preeclampsia, high discriminatory performance or strong likelihood ratios (LRs) have been demonstrated for PlGF for combined adverse maternal and fetal outcomes (usually the need for delivery with pre-eclampsia within 7–14 days) [ 10 , 14 – 18 ]; however there are limited studies reporting on solely maternal outcomes [ 18 – 22 ].…”

Section: Introductionmentioning

confidence: 99%

“…Ethics approval was obtained from the individual study sites in the original study by Quidel triage Inc [ 14 ] while a data sharing agreement was made between the University of British Columbia and Quidel triage Inc. to access anonymized data for this study. This study was part of a multinational validation study approved by the University of British Columbia Research Ethics Board (CREB no: H07–02207).…”

mentioning

confidence: 99%

See 4 more Smart Citations

Placental growth factor for the prognosis of women with preeclampsia (fullPIERS model extension): context matters

Ukah

Payne

Hutcheon

et al. 2020

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

Background The fullPIERS risk prediction model was developed to identify which women admitted with confirmed diagnosis of preeclampsia are at highest risk of developing serious maternal complications. The model discriminates well between women who develop (vs. those who do not) adverse maternal outcomes. It has been externally validated in several populations. We assessed whether placental growth factor (PlGF), a biomarker associated with preeclampsia risk, adds incremental value to the fullPIERS model. Methods Using a cohort of women admitted into tertiary hospitals in well-resourced settings (the USA and Canada), between May 2010 to February 2012, we evaluated the incremental value of PlGF added to fullPIERS for prediction of adverse maternal outcomes within 48 h after admission with confirmed preeclampsia. The discriminatory performance of PlGF and the fullPIERS model were assessed in this cohort using the area under the receiver’s operating characteristic curve (AUROC) while the extended model (fullPIERS +PlGF) was assessed based on net reclassification index (NRI) and integrated discrimination improvement (IDI) performances. Results In a cohort of 541 women delivered shortly (< 1 week) after presentation, 8.1% experienced an adverse maternal outcome within 48 h of admission. Prediction of adverse maternal outcomes was not improved by addition of PlGF to fullPIERS (NRI: -8.7, IDI − 0.06). Discriminatory performance (AUROC) was 0.67 [95%CI: 0.59–0.75] for fullPIERS only and 0.67 [95%CI: 0.58–0.76]) for fullPIERS extended with PlGF, a performance worse than previously documented in fullPIERS external validation studies (AUROC > 0.75). Conclusions While fullPIERS model performance may have been affected by differences in healthcare context between this study cohort and the model development and validation cohorts, future studies are required to confirm whether PlGF adds incremental benefit to the fullPIERS model for prediction of adverse maternal outcomes in preeclampsia in settings where expectant management is practiced.

show abstract

Section: Introductionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Placental growth factor for the prognosis of women with preeclampsia (fullPIERS model extension): context matters

Ukah

Payne

Hutcheon

et al. 2020

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

show abstract

Biochemical tests of placental function versus ultrasound assessment of fetal size for stillbirth and small-for-gestational-age infants

Heazell

Hayes

Whitworth

et al. 2019

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

show abstract

Comparison of circulating maternal placenta growth factor levels and sonographic evaluation of patients with abnormal first trimester screening analytes

et al. 2023

View full text Add to dashboard Cite

Objective: To evaluate the role of mid-trimester placental growth factor (PlGF) in patients with abnormal circulating levels of first-trimester biomarkers.Methods: Retrospective cohort study including singleton pregnancies complicated by abnormal first-trimester biomarkers (2017-2020). Pregnancies complicated with chromosomal/structural anomalies were excluded. All patients had ultrasound imaging including uterine artery Doppler combined with measurement of maternal circulating PlGF. Sonographic findings, maternal and perinatal outcomes, and placental histopathology were compared between pregnancies with normal and low (<10th percentile for gestational age) PlGF levels. The diagnostic accuracy of PlGF for the prediction of specific placental-mediated complications was compared with the uterine artery Doppler assessment and additional sonographic findings.Results: Seventy-one pregnancies were assessed, of which 35 (49.3%) had low PlGF levels. Maternal sociodemographic characteristics, nulliparity, and aspirin consumption were comparable. In comparison with patients with normal PlGF levels, individuals with low PlGF levels had a higher rate of fetal growth restriction (EFW <3rd centile; 42.9% vs. 8.3%, p = 0.001), preterm-preeclampsia (22.9% vs. 0%, p = 0.002), preterm delivery <34 weeks (54.3% vs. 8.3%, p < 0.001) and maternal vascular malperfusion placental pathology (72.7% vs. 21.7%, p < 0.001) following delivery. Adjusting for uterine artery Doppler and fetal biometry status, midtrimester low PlGF remained significantly associated with these placentalmediated complications. The predictive capacity of PlGF outperformed ultrasound imaging with only minimal diagnostic improvement when ultrasound information was combined with PlGF status. Conclusion:In pregnancies with unexplained abnormal first-trimester biomarkers, mid-trimester PlGF outperformed a comprehensive ultrasound assessment in the identification of a subset of patients destined to develop placental dysfunction. This blood test may be an alternative initial approach in this context, especially where access to specialist care is more geographically challenging.

show abstract

Placental growth factor predicts time to delivery in women with signs or symptoms of early preterm preeclampsia: a prospective multicenter study

Cited by 54 publications

References 16 publications

Placental growth factor for the prognosis of women with preeclampsia (fullPIERS model extension): context matters

Placental growth factor for the prognosis of women with preeclampsia (fullPIERS model extension): context matters

Biochemical tests of placental function versus ultrasound assessment of fetal size for stillbirth and small-for-gestational-age infants

Comparison of circulating maternal placenta growth factor levels and sonographic evaluation of patients with abnormal first trimester screening analytes

Contact Info

Product

Resources

About