Role of sFLT-1/PlGF ratio in predicting severe adverse materno-fetal outcome in high risk women

Abstract

Objective: To evaluate the role of angiogenic biomarkers in predicting severe adverse materno-fetal outcome (SAO) among women at high risk of preeclampsia (PE).

Method: All antenatal women at high risk of PE underwent MAP estimation, sFlt-1/PlGF ratio, uterine artery evaluation at 20-22, 28-30 and 34-36 weeks of gestation and were followed until delivery. The severe adverse outcome included severe PE, severe fetal growth restriction with Doppler changes and intrauterine death or early neonatal death. Those who developed SAO were cases and rest were controls, the cases and controls were compared using univariate and multivariate logistic regression analysis.

Results: In 54/287(18.8 %) SAO was observed, and they comprised of severe PE (21/287, 7.3 %), FGR with absent or reverse diastolic flow on Doppler (23/287, 8.0 %) and intrauterine death or early neonatal death (10/287, 3.5 %). For detecting complications up to 30 weeks, the sFLT-1/PlGF ratio at 20 weeks (cut off ≥ 38) was the best test (accuracy- 97.6 %) followed by MAP and uterine artery Doppler PI. For detecting complications up to 34 weeks, prediction was good (accuracy -80.4 %) when sFLT-1/PlGF ratio was combined with uterine artery PI. The predictive value of the complications before 34 weeks was far superior to that after 34 weeks. Combining the sFLT-1/PlGF ratio with the uterine artery PI improved the accuracy of the test (79 % to 87 %).

Conclusion: Increased sFlt-1/PlGF ratio, was a good predictive marker for SAO in the study population. The accuracy of prediction was better for those who developed the complications before 34 weeks.

Keywords: Biomarkers; Early onset preeclampsia; Hypertension in pregnancy; India; Preeclampsia prediction.