Maternal serum placental growth factor at 11 + 0 to 13 + 6 weeks of gestation in the prediction of pre-eclampsia (original) (raw)
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Ultrasound in Obstetrics & Gynecology, 2021
Objective: To compare the screening performance of serum pregnancy-associated plasma protein-A (PAPP-A) versus placental growth factor (PlGF) in routine first trimester combined screening for preeclampsia (PE), small for gestational age (SGA) birth and trisomy 21. Methods: Retrospective study nested in pregnancy cohorts undergoing first trimester combined screening for PE and trisomy 21 using the Fetal Medicine Foundation (FMF) algorithm based on maternal characteristics, nuchal translucency, PAPP-A, free beta-human chorionic gonadotropin, blood pressure and uterine artery Doppler. Women at high-risk for preterm PE (≥1 in 50) received 150 mg aspirin, serial fetal growth scans at 28 and 36 weeks and were offered elective birth from 40 weeks of gestation. PlGF was retrospectively quantified in stored surplus first-trimester serum samples. The performance of combined first trimester screening for PE, SGA and trisomy 21 using either PAPP-A or PlGF was calculated. Results: Maternal serum PAPP-A was assayed in 1094 women including 82 with PE, 111 with SGA <10 th centile, 53 with both PE and SGA <10 th centile, and 94 with trisomy 21. PlGF levels were retrospectively obtained from 1066 out of 1094 women. Median serum PlGF MoM was significantly lower in PE (1.0, IQR=0.8-1.4, P<0.01), SGA (1.0, IQR=0.8-1.3, P<0.001) and trisomy 21 pregnancies (0.6, IQR=0.5-0.9, P<0.0001) compared to controls (1.2, IQR=0.9-1.5). There was no significant difference in the performance of first trimester screening using PAPP-A versus PlGF for either preterm PE (AUC 0.78 vs 0.79, P=0.55) or term PE (AUC 0.74 vs 0.74, P=0.60). These findings persisted even after correction for the effect of targeted aspirin use on prevalence of PE. Similarly, there were no significant differences in combined screening sensitivity or specificity for SGA or trisomy 21 when using PAPP-A versus PlGF. Conclusion: Using PlGF or PAPP-A in routine first trimester combined screening with maternal characteristics, blood pressure and uterine artery Doppler does not make an appreciable clinical difference to the detection of PE or SGA. Depending on the setting, biomarkers should be chosen to achieve a good compromise between performance and measurement requirements. This pragmatic effectiveness study suggests that combined screening for PE can be successfully implemented in public healthcare settings without changing current protocols for the assessment of PAPP-A in the first trimester.
The Egyptian Journal of Hospital Medicine
Background: Preeclampsia is a major contributor of maternal and perinatal morbidity and mortality. The purpose of this study was to look at the predictive usefulness of placental growth factor (PLGF), maternal characteristics (MC), and uterine artery Doppler for preeclampsia in the first trimester. Patients and methods: A cross-sectional survey was conducted on 805 pregnant women between 11 + 0 and 13 + 6 weeks' gestation. A complete history and clinical examination were taken at the booking visit, a bilateral uterine artery Doppler study was estimated, and the mean pulse index (PI) was computed and recorded. A venous blood sample was drawn and centrifuged for 10 minutes at 3000 rpm to extract the serum, which was then frozen at 80 C for further examination for placental growth factor (PLGF). Results: PE developed in 54 (6.7%) cases; 11 (20.4%) early-onset and 43 (79.6%) late-onset. The following parameters were calculated: sensitivity, specificity, positive and negative value (PPV and NPV), and accuracy. The sensitivities for MC, PLGF and UADPI for prediction of early-onset preeclampsia were 27.3%, 54.5%, and 72.7%, respectively. The sensitivities for MC, PLGF and UADPI for prediction of late-onset preeclampsia were 14%, 55.8%, and 51.2%, respectively. The sensitivity for combination between the three factors used to predict PE were 85.7% for early-onset and 79.4% for late-onset preeclampsia, respectively. Conclusions: Effective screening for PE may be accomplished in the first trimester of pregnancy, at 11-14 weeks' gestation, by combining maternal features with the findings of uterine artery Doppler and placental growth factor to determine the risk of PE development.
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2012
To determine the effectiveness of the combined use of uterine artery Doppler velocimetry (UADV) and estimation of maternal serum placental growth factor (PlGF) levels in early second trimester (20-22 weeks of gestation) in identifying pregnant women at risk of developing pre-eclampsia. Study design: Prospective cohort study on 1104 pregnant women with singleton pregnancies between May 2009 and December 2010. UADV and maternal serum PlGF estimation were done at 20-22 weeks' gestation. Association between the two variables and the occurrence of pre-eclampsia was analyzed by logistic regression analysis and odds ratio was computed. The results were considered significant when p was <0.05. Results: Logistic regression analysis showed that both abnormal UADV (odds ratio (OR) 4.1; 95% CI 2.3-7.2; p = 0.000) and serum PlGF < 188 pg/ml (OR 3.6; 95% CI 1.95-6.5; p = 0.000) are independent variables in the occurrence of pre-eclampsia, and the difference between the association of these two variables with pre-eclampsia was statistically insignificant as 95% CI values overlap. Multivariate logistic regression analysis showed that a combination of abnormal UADV and serum PlGF < 188 pg/ml at 20-22 weeks had a very poor association (OR 1.1; 95% CI 0.3-3.8; p = 0.938) with the occurrence of preeclampsia, as the 95% CI values encompass 1 and p is >0.05. Conclusion: UADV and maternal serum PlGF estimation at 20-22 weeks of gestation are strong predictors of the occurrence of pre-eclampsia when used individually but in combination their association with pre-eclampsia is not significant.
Archives of Gynecology and Obstetrics, 2012
Purpose To determine whether maternal serum placental growth factor (PlGF) is more effective as a biomarker in predicting the occurrence of early onset preeclampsia in first trimester or early second trimester of pregnancy. Methods A prospective cohort study was conducted on women with singleton pregnancies, screened from the antenatal clinic. Serum PlGF estimation was done at 11-14 weeks of gestation on 1,244 women and at 22-24 weeks of gestation on 1,206 women from the initial study population. A cutoff value of \228 pg/ml for serum PlGF at 11-14 weeks of gestation and \144 pg/ml for serum PlGF at 22-24 weeks of gestation were determined by receiver operating characteristic (ROC) curve analysis for identifying pregnant women at risk of developing early onset preeclampsia (\32 weeks of gestation). Univariate logistic regression analysis was used to analyze the association between serum PlGF \ 228 pg/ml at 11-14 weeks of gestation and \144 pg/ml at 22-24 weeks of gestation with the occurrence of early onset preeclampsia and odds ratio (OR) was computed. P value \ 0.05 was considered statistically significant in this study. Results Maternal serum PlGF\144 pg/ml at 22-24 weeks of gestation had a stronger association (OR 18.83; 95 % CI 12.08-22.24; p = 0.000) than serum PlGF \228 pg/ml at 11-14 weeks of gestation (OR 2.76; 95 % CI 1.29-3.94; p = 0.007) with the occurrence of early onset preeclampsia. The sensitivity and specificity of serum PlGF\144 pg/ml at 22-24 weeks of gestation (84 and 78, respectively) were much higher than those of serum PlGF \228 pg/ml at 11-14 weeks of gestation (58 and 66, respectively) in predicting early onset preeclampsia. Conclusion Maternal serum PlGF may be more effective as a biomarker in early second trimester than in first trimester of pregnancy, in predicting the occurrence of early onset preeclampsia.
American Journal of Obstetrics and Gynecology, 2007
OBJECTIVE: Preeclampsia has been proposed to be an anti-angiogenic state that may be detected by the determination of the concentrations of the soluble vascular endothelial growth factor receptor-1 (sVEGFR-1) and placental growth factor (PlGF) in maternal blood even before the clinical development of the disease. The purpose of this study was to determine the role of the combined use of uterine artery Doppler velocimetry (UADV) and maternal plasma PlGF and sVEGFR-1 concentrations in the second trimester for the identification of patients at risk for severe and/or early onset preeclampsia.
Ultrasound in Obstetrics & Gynecology, 2016
Objective To estimate the patient-specific risk of pre-eclampsia (PE) at 31-34 weeks' gestation by a combination of maternal characteristics and medical history with multiples of the median (MoM) values of serum placental growth factor (PlGF) and serum soluble fms-like tyrosine kinase-1 (sFlt-1) and to compare the performance of screening to that achieved by the sFlt-1/PlGF ratio. Methods This was a prospective observational study in women attending a third-trimester ultrasound scan at 31-34 weeks as part of routine pregnancy care. We estimated the performance of screening for PE with delivery within 4 weeks of assessment and PE with delivery from 4 weeks after assessment up to 40 weeks' gestation by the sFlt-1/PlGF ratio and by a method utilizing Bayes' theorem that combines maternal factors and MoM values of sFlt-1 and PlGF. The significance of the difference in screening performance between the two methods was assessed by comparison of the areas under the receiver-operating characteristics curves (AUC). Results The study population of 8063 singleton pregnancies included 231 (2.9%) that subsequently developed PE. In the prediction of delivery with PE at < 4 weeks from assessment, the performance of the method utilizing Bayes' theorem was similar to that using the sFlt-1/PlGF ratio (AUC, 0.987 (95% CI, 0.979-0.995) vs 0.988 (95% CI, 0.981-0.994); P = 0.961). In contrast, the performance of screening for delivery with PE at ≥ 4 weeks after assessment up to 40 weeks' gestation was better with the method utilizing Bayes' theorem than that with the sFlt-1/PlGF ratio (AUC, 0.884 (95% CI, 0.854-0.914) vs 0.818 (95% CI, 0.775-0.860); P < 0.0001). Conclusion At 31-34 weeks' gestation the performance of screening for PE delivering at < 4 weeks from assessment by the method utilizing Bayes' theorem is similar to
Serum PLGF as a potential biomarker for predicting the onset of preeclampsia
Archives of Gynecology and Obstetrics, 2012
Purpose Preeclampsia is one of the leading causes of maternal and perinatal morbidity and mortality. Till date despite years of research into the condition, predicting the onset of preeclampsia remains a problem. Placental growth factor is one of the many angiogenic factors, which shows significant altered levels in preeclampsia compared to normal pregnancy. The present study aims to analyze whether estimation of serum PLGF levels in late second trimester can act as a predictor of preeclampsia. Methods A total of 150 nulliparous pregnant women admitted in antenatal wards or attending antenatal clinic were included in the study. They were divided into three groups: 30 women being normotensive and 60 each with diagnosed mild and severe preeclampsia, respectively. Serum samples collected from the study groups were subjected to ELISA, and serum PLGF level was calculated in all the samples. Results Mean serum PLGF levels were found to be significantly low in mild and severe preeclampsia as compared to normal pregnancy. Serum PLGF levels were highest at 26-28 weeks and were lowered at 28-30 and 30-32 weeks of gestation within each of the three study groups. Cutoff value of serum PLGF levels for predicting mild and severe preeclampsia was calculated statistically from the analyzed data.
Journal of obstetrics and gynaecology of India, 2016
Preeclampsia is a leading cause of maternal and perinatal mortality and morbidity, but signs and symptoms are non-specific and may vary. The root cause is imbalance of circulating angiogenic factors of placental (syncytiotrophoblast) origin, with consequent low levels of placental growth factor (PlGF) which may aid in diagnosis and prediction of disease. To study the incidence of women at risk of developing early-onset preeclampsia by plasma placental growth factor biomarker assay in high-risk patients, to assess the maternal outcome in patients with PlGF values below cutoff for presenting gestational age, to calculate sensitivity, specificity, positive predictive value and negative predictive value of PlGF assay in predicting preeclampsia and to conclude whether PlGF biomarker assay can be an effective screening test in high-risk patients for prediction of early-onset preeclampsia. The study was carried out in the Department of Obstetrics and Gynecology at a tertiary care center. I...
Journal of Obstetrics and Gynaecology Research, 2013
To determine whether maternal serum placental growth factor (PlGF) estimation in early second trimester (20-22 weeks of gestation) can predict the occurrence of early onset preeclampsia and/or early onset intrauterine growth restriction (IUGR). Material and Methods: A prospective cohort study was conducted on 722 women with singleton pregnancies, screened from the antenatal clinic, and serum PlGF levels were estimated at 20-22 weeks of gestation. A cut-off value of <155 pg/mL for serum PlGF was determined by receiver operating characteristic (ROC) curve analysis for identifying pregnant women at risk of developing early onset preeclampsia and/or early onset IUGR. Preeclampsia and IUGR were classified as early onset when diagnosed by 32 weeks of gestation. Univariate logistic regression analysis was used to analyze the association between serum PlGF level <155 pg/mL and the two outcome measures (i.e. early onset preeclampsia and early onset IUGR) and odds ratio (OR) was computed. P-value < 0.05 was considered statistically significant. Results: Maternal serum PlGF level <155 pg/mL at 20-22 weeks of gestation had a strong association with early onset preeclampsia (OR 8.35; 95% CI 1.79-18.94; P = 0.007) and with early onset IUGR (OR 10.73; 95% CI 4.08-20.23; P = 0.000). The sensitivity of serum PlGF < 155 pg/mL for predicting early onset preeclampsia and early onset IUGR were 82 and 84, respectively. Conclusion: Maternal serum PlGF level estimation in early second trimester (20-22 weeks of gestation) may be useful in predicting the occurrence of early onset preeclampsia and/or early onset IUGR.