PlGF in a clinical setting of pregnancies at risk of preeclampsia and/or intrauterine growth restriction

Abstract

Placental growth factor (PlGF) is an angiogenic molecule produced by the placenta and implicated in the pathogenesis of preeclampsia (PE) and intrauterine growth restriction (IUGR). We have evaluated utility and applicability of the PlGF test in a clinical setting of pregnancies at risk of PE or complicated by IUGR in order to assess its relationship with pregnancy outcomes. Seventy-three pregnancies were enrolled between 19 and 35 weeks: 57 pregnancies at risk of PE and 16 at diagnosis of IUGR. Maternal circulating PlGF levels were measured by the Triage PlGF test (Alere, San Diego, CA). Pregnancy outcomes were evaluated in relation to three categories of plasma PlGF levels: very low (<12 pg/ml), low (12-100 pg/ml) and normal (≥100 pg/ml). Uterine artery Doppler velocimetry (UADV) pulsatility index (PI) was measured in the same patients on the day of maternal sampling. Pregnancies at risk with very low plasma PlGF levels had significantly lower gestational age at delivery than patients with low or normal PlGF. The rate of emergency C-section was significantly higher in the group with PlGF<12 pg/ml. IUGR pregnancies with very low and low PlGF delivered earlier than patients with normal PlGF. All IUGR with very low and low PlGF had UADV PI > 95th percentile. Our data indicate that PlGF may provide useful information to identify fetuses requiring increased surveillance and possibly urgent delivery in pregnancies at risk of adverse outcomes. Furthermore, in IUGR, PlGF can predict adverse pregnancy outcomes that may be secondary to placental insufficiency.

Predictive value of soluble fms‐like tyrosine kinase‐1 against placental growth factor for preeclampsia in a Chinese pregnant women population

“…Mijal et al found that the serum level of PlGF in preeclampsia pregnant women was significantly decreased by comparing with normal pregnant women . Cetin I et al found that PlGF level could be used to predict the risk associated with adverse pregnancy such as very low birthweight infants and emergency childbirth . However, our results showed that the level of serum PlGF in preeclampsia group was significantly lower than that in normal pregnancy control group ( P < 0.05) and indicated that placental growth factor was a protective factor for preeclampsia.…”

“…8 Cetin I et al found that PlGF level could be used to predict the risk associated with adverse pregnancy such as very low birthweight infants and emergency childbirth. 9 However, our results showed that the level of serum PlGF in preeclampsia group was significantly lower than that in normal pregnancy control group (P < 0.05) and indicated that placental growth factor was a protective factor for preeclampsia. Many researches advocated that low level of PlGF in pregnant women could auxiliary diagnosis preeclampsia by specific binding sFlt-1.…”

Effects of maternal obesity on placental function and fetal development

“…Elevated levels of sFlt1 sequester VEGF and PlGF to reduce their bioavailability for the membrane-bound receptors and therefore disrupts the angiogenic balance required for proper placental vascular remodeling and angiogenesis (Lecarpentier and Tsatsaris, 2016). Preeclampsia is associated with increased maternal serum levels of sFlt1 and pro-inflammatory TNF-α (Spradley et al 2015), which are linked to maternal hypertensive disorders and fetal growth restriction (Cetin et al 2016; Moran et al 2015). Rodent studies indicate that high fat diets may impair the development of the placental vasculature as evidenced by increased hypoxia in the labyrinth and fetal death was three fold higher in dams fed high fat diets (Hayes et al 2012).…”

The role of angiogenic factors in the management of preeclampsia

“…The algorithm categorizes patients into care levels according to BP and a PlGF cutoff (traffic light) system. In 2017, Cetin and colleagues found that, in those at risk of PE, very low plasma PlGF (<12 pg/mL) was associated with a higher emergency cesarean section rate and earlier delivery . 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 .…”