Prediction of adverse perinatal outcome and the mean time until delivery in twin pregnancies with suspected pre-eclampsia using sFlt-1/PIGF ratio

Karge, Anne; Seiler, Alina; Flechsenhar, Sarah; Haller, Bernhard; Ortiz, JU; Lobmaier, SM; Axt-Fliedner, R; Enzensberger, C; Abel, Kathrin; Kuschel, Bettina; Graupner, O

doi:10.1016/j.preghy.2021.02.003

Cited by 13 publications

(21 citation statements)

References 49 publications

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“…Patients with twin pregnancies are twice prone to develop preeclampsia compared to those with singleton pregnancies [19, 22, 23]. It has been reported that the sFlt-1/PlGF ratio may be helpful to predict selective FGR (sFGR) in twin pregnancies with preeclampsia and/or HELLP [24]. Nevertheless, there is a lack of data regarding the sFlt-1/PlGF ratio in uneventful twin pregnancies to predict the development of diseases related to placental dysfunction.…”

Section: Introductionmentioning

confidence: 99%

sFlt-1/PlGF Ratio at 24 Weeks Gestation in Twin Pregnancies as a Predictor of Preeclampsia or Fetal Growth Restriction

et al. 2022

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Introduction: The objective was to elucidate if the sFlt-1/PlGF ratio at 24 weeks in twin pregnancies could be useful to select patients who subsequently develop diseases related to placental dysfunction, such as preeclampsia or fetal growth restriction (FGR). Methods: This was a prospective study among all twin pregnancies followed up at a tertiary hospital. The sFlt-1/PlGF ratio was determined at 24 weeks. Results: A total of 108 patients with a twin gestation were included. Pregnant women who developed preeclampsia and/or FGR displayed a significantly higher sFlt-1/PlGF ratio at 24 weeks, compared to those who did not develop these diseases (20.3 vs. 4.3, p = 0.002). The mean sFlt-1/PlGF ratio was not significantly different between patients who subsequently developed preeclampsia compared with those that developed FGR (29.8 vs. 18.45, p = 0.42). A sFlt-1/PlGF ratio ≥17 at 24 weeks is associated with a significant increase in the frequency of preeclampsia (odds ratio, 37.13 [95% confidence interval, 4.78–288.25]; p = 0.002), and FGR (odds ratio, 39.58 [95% confidence interval, 6.31–248.17]; p < 0.001). The addition of maternal characteristics and mean pulsatility index of the uterine arteries to the sFlt-1/PlGF ratio at 24 weeks enhances the identification of patients who develop preeclampsia or FGR. Conclusion: The sFlt-1/PlGF ratio at 24 weeks in twin pregnancies, combined with the mean pulsatility index of the uterine arteries and maternal characteristics, could select patients who develop preeclampsia or FGR. These patients might benefit from a close follow-up in order to avoid maternal-fetal adverse outcomes.

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Section: Introductionmentioning

confidence: 99%

sFlt-1/PlGF Ratio at 24 Weeks Gestation in Twin Pregnancies as a Predictor of Preeclampsia or Fetal Growth Restriction

et al. 2022

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“…Furthermore, in fetuses with normal Doppler parameters, those with EFW <3rd centile showed a higher rate of CS for fetal distress and longer neonatal hospitalization compared to those with EFW >3rd centile and BW >10th centile [14]. In addition, a prospective study including a large cohort pointed out that SGA fetuses with low abdominal circumference have a particularly higher risk of being affected by APO, indicating the importance of fetal size itself in detecting FGR situations [33]. Therefore, a BW <3rd centile reflects placental insufficiency in many cases and an EFW <3rd centile should be handled as an FGR independently of the fetal Doppler status as suggested by the Delphi consensus [12].…”

Section: Discussionmentioning

confidence: 96%

“…Accordingly, our analysis confirmed a low predictive performance of CPR in the SGA group. Serum parameters reflecting placental insufficiency, such as sFlt-1/PIGF, might help detect cases of SGA with a higher risk of APO, but their meaning for APO prediction in high-risk cohorts is still controversial [29][30][31][32][33].…”

Section: Discussionmentioning

confidence: 99%

Value of Cerebroplacental Ratio and Uterine Artery Doppler as Predictors of Adverse Perinatal Outcome in Very Small for Gestational Age at Term Fetuses

Karge

Lobmaier

Haller

et al. 2022

JCM

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The aim of this study was to evaluate the association between cerebroplacental ratio (CPR), mean uterine artery (mUtA) Doppler and adverse perinatal outcome (APO) and their predictive performance in fetuses with birth weight (BW) <3rd centile (very small for gestational age, VSGA) in comparison with fetuses with BW 3rd–10th centile (small for gestational age, SGA). This was a retrospective cohort study including singleton pregnancies delivered at term (37 + 0–41 + 6) in a single tertiary referral center over a six-year period. APO was defined as a composite of cesarean section for intrapartum fetal compromise (IFC), umbilical artery pH < 7.20, and admission to the neonatal intensive care unit for >24 h. The characteristics of the study population according to BW (VSGA and SGA) as well as the presence of composite APO were assessed. The prognostic performance of CPR and mUtA-PI was evaluated using receiver operating characteristic (ROC) analysis. In total, 203 pregnancies were included. Of these, 55 (27%) had CPR <10th centile, 25 (12%) mUtA-PI >95th centile, 65 (32%) VSGA fetuses, and 93 (46%) composite APO. VSGA showed a non-significantly higher rate of composite APO in comparison to SGA (52% vs. 43%; p = 0.202). The composite APO rate was significantly higher in SGA with CPR <10th centile (36% vs. 13%; p = 0.001), while in VSGA with CPR <10th centile was not (38% vs. 35%; p = 0.818). The composite APO rate was non-significantly higher both in VSGA (26% vs. 10%; p = 0.081) and SGA (14% vs. 6%; p = 0.742) with mUtA-PI >95th centile. The ROC analysis showed a significantly predictive value of CPR for composite APO in SGA only (AUC 0.612; p = 0.025). A low CPR was associated with composite APO in SGA fetuses. VSGA fetuses were more frequently affected by composite APO regardless of Doppler values. The predictive performance of CPR and uterine artery Doppler was poor.

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“…As obesity is an epidemic disease affecting more and more pregnancies, outcome prediction in this subgroup is of urgent need. Outcome prediction in pre-eclamptic women using (anti-)angiogenic factors, especially sFlt-1/PIGF, was evaluated over the last decade [ 16 , 19 , 34 ]. In our study cohort, sFlt-1/PIGF had a high prognostic value for APO, a finding in line with previous publications of our working group [ 20 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…The ratio of sFlt-1/PIGF is not only used for diagnosing or excluding PE, but also for the prediction of adverse perinatal outcome (APO) and adverse maternal outcome (AMO) [ 13 , 14 , 15 , 16 ]. Specifically, highly elevated levels of sFlt-1/PIGF correlate with APO and might be helpful for estimating the mean time until delivery [ 12 , 17 , 18 , 19 , 20 ]. Likewise, published data do not discriminate between different BMI groups.…”

Section: Introductionmentioning

confidence: 99%

Performance of sFlt-1/PIGF Ratio for the Prediction of Perinatal Outcome in Obese Pre-Eclamptic Women

Karge

Desing

Haller

et al. 2022

JCM

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Obese women are at high risk of developing pre-eclampsia (PE). As an altered angiogenic profile is characteristic for PE, measurement of soluble fms-like tyrosine kinase-1 (sFlt-1)/placental growth factor (PIGF) ratio in the maternal serum can be helpful for PE diagnosis, as well as for adverse perinatal outcome (APO) prediction. There is growing evidence that obesity might influence the level of sFlt-1/PIGF and, therefore, the aim of the study was the evaluation of sFlt-1/PIGF as an APO predictor in obese women with PE. Pre-eclamptic women who had an sFlt-1/PIGF measurement at the time of diagnosis were retrospectively included. Women were classified according to their pre-pregnancy body mass index (BMI) as normal weight (BMI < 25 kg/m2), overweight (BMI > 25–29.9 kg/m2) or obese (BMI ≥ 30 kg/m2). APO was defined as the occurrence of one of the following outcomes: Small for gestational age, defined as a birthweight < 3rd centile, neonatal mortality, neonatal seizures, admission to neonatal unit required (NICU) or respiratory support. A total of 141 women were included. Of them, 28 (20%) patients were obese. ROC (receiver operating characteristic) analysis revealed a high predictive value for sFlt-1/PIGF and APO across the whole study cohort (AUC = 0.880, 95% CI: 0.826–0.936; p < 0.001). However, the subgroup of obese women showed a significantly lower level of sFlt-1 and, therefore, the performance of sFlt-1/PIGF as APO predictor was poorer compared to normal or overweight PE women (AUC = 0.754, 95% CI: 0.552–0.956, p = 0.025). In contrast to normal or overweight women, a ratio of sFlt-1/PIGF < 38 could not rule out APO in women with obesity.

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Prediction of adverse perinatal outcome and the mean time until delivery in twin pregnancies with suspected pre-eclampsia using sFlt-1/PIGF ratio

Cited by 13 publications

References 49 publications

sFlt-1/PlGF Ratio at 24 Weeks Gestation in Twin Pregnancies as a Predictor of Preeclampsia or Fetal Growth Restriction

sFlt-1/PlGF Ratio at 24 Weeks Gestation in Twin Pregnancies as a Predictor of Preeclampsia or Fetal Growth Restriction

Value of Cerebroplacental Ratio and Uterine Artery Doppler as Predictors of Adverse Perinatal Outcome in Very Small for Gestational Age at Term Fetuses

Performance of sFlt-1/PIGF Ratio for the Prediction of Perinatal Outcome in Obese Pre-Eclamptic Women

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