Maternal and Perinatal Outcomes Associated With Extremely High Values for the sFlt-1 (Soluble fms-Like Tyrosine Kinase 1)/PlGF (Placental Growth Factor) Ratio

• Published in: Journal of the American Heart Association 2020-04, Vol.9 (7), p.e015548-e015548
• Main Authors: Villalaín, Cecilia, Herraiz, Ignacio, Valle, Leonor, Mendoza, Manel, Delgado, Juan Luis, Vázquez-Fernández, María, Martínez-Uriarte, Juan, Melchor, Íñigo, Caamiña, Sara, Fernández-Oliva, Antoni, Villar, Olga Patricia, Galindo, Alberto
• Format: Article
• Language: English
• Subjects: Biomarkers - blood; Delivery, Obstetric; Disease Progression; Female; fetal growth restriction; Fetal Growth Retardation - blood; Fetal Growth Retardation - diagnosis; Fetal Growth Retardation - mortality; Fetal Growth Retardation - physiopathology; Humans; Infant, Newborn; Original Research; Perinatal Mortality; Placenta Growth Factor - blood; placental dysfunction; placental growth factor; Pre-Eclampsia - blood; Pre-Eclampsia - diagnosis; Pre-Eclampsia - mortality; Pre-Eclampsia - physiopathology; Predictive Value of Tests; preeclampsia; Pregnancy; Retrospective Studies; Risk Assessment; Risk Factors; Severity of Illness Index; sFlt1; Spain; Time Factors; Up-Regulation; Vascular Endothelial Growth Factor Receptor-1 - blood
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.119.015548

Background There is little knowledge about the significance of extremely high values (>655) for the ratio of sFlt-1 (soluble fms-like tyrosine kinase 1) to PlGF (placental growth factor). We aim to describe the time-to-delivery interval and maternal and perinatal outcomes when such values are demonstrated while assessing suspected or confirmed placental dysfunction based on clinical or sonographic criteria. Methods and Results A multicenter retrospective cohort study was performed on 237 singleton gestations between 20+0 and 37+0 weeks included at the time of first demonstrating a sFlt-1/PlGF ratio >655. Clinicians were aware of this result, but standard protocols were followed for delivery indication. Main outcomes were compared for women with and without preeclampsia at inclusion. In those with preeclampsia (n=185, of whom 77.3% had fetal growth restriction), severe preeclampsia features and fetal growth restriction in stages III or IV were present in 49.2% and 13.5% cases, respectively, at inclusion and in 77.3% and 28.6% cases, respectively, at delivery. In the group without preeclampsia (n=52, 82.7% had fetal growth restriction), these figures were 0% and 30.8%, respectively, at inclusion and 21.2% and 50%, respectively, at delivery. Interestingly, 28% of women without initial preeclampsia developed it later. The median time to delivery was 4 days (interquartile range: 1-6 days) and 7 days (interquartile range: 3-12 days), respectively ( 655 is almost invariably associated with preeclampsia or fetal growth restriction that progresses rapidly. In our tertiary care settings, we observed that maternal adverse outcomes were high throughout gestation, whereas perinatal adverse outcomes diminished as pregnancy advanced.