Circulating Angiogenic Factors and Risk of Adverse Maternal and Perinatal Outcomes in Twin Pregnancies With Suspected Preeclampsia

• Published in: Hypertension (Dallas, Tex. 1979) Tex. 1979), 2012-08, Vol.60 (2), p.451-458
• Main Authors: Rana, Sarosh, Hacker, Michele R, Modest, Anna Merport, Salahuddin, Saira, Lim, Kee-Hak, Verlohren, Stefan, Perschel, Frank H, Karumanchi, S Ananth
• Format: Article
• Language: English
• Subjects: Acute Kidney Injury - epidemiology; Adult; Arterial hypertension. Arterial hypotension; Biological and medical sciences; Biomarkers - blood; Blood and lymphatic vessels; Cardiology. Vascular system; Cohort Studies; Diseases of mother, fetus and pregnancy; Female; Fetal Death - epidemiology; Gynecology. Andrology. Obstetrics; Humans; Infant, Newborn; Medical sciences; Placenta Growth Factor; Pre-Eclampsia - blood; Predictive Value of Tests; Pregnancy; Pregnancy Complications, Cardiovascular - blood; Pregnancy Outcome; Pregnancy Proteins - blood; Pregnancy Trimester, Third; Pregnancy, Twin; Pregnancy. Fetus. Placenta; Prospective Studies; Pulmonary Edema - epidemiology; Risk Factors; Vascular Endothelial Growth Factor Receptor-1 - blood
• ISSN: 0194-911X; 1524-4563
• DOI: 10.1161/HYPERTENSIONAHA.112.195065

To evaluate whether angiogenic factor levels correlate with preeclampsia-related adverse maternal and perinatal outcomes in women with twin pregnancy, we studied 79 women with suspected preeclampsia in the 3rd trimester. Antiangiogenic soluble fms-like tyrosine kinase-1 (sFlt-1) and proangiogenic placental growth factor (PlGF) were measured at presentation on an automated platform. An adverse outcome was defined as hemolysis, elevated liver enzymes, and low platelets syndrome; disseminated intravascular coagulation; abruption; pulmonary edema; cerebral hemorrhage; maternal, fetal, and neonatal death; eclampsia; acute renal failure; small for gestational age; and indicated delivery. All outcomes were ascertained 2 weeks after initial evaluation. Comparing the 52 women (65.8%) who experienced an adverse outcome with the 27 women (34.2%) without an adverse outcome, the median sFlt-1 was elevated (11461.5 pg/mL [8794.0–14847.5] versus 7495.0 pg/mL [3498.0–10482.0; P=0.0004]), PlGF was reduced (162.5 pg/mL [98.0–226.5] versus 224.0 pg/mL [156.0–449.0]; P=0.005), and sFlt-1/PlGF ratio was elevated (74.2 [43.5–110.5] versus 36.2 [7.1–71.3]; P=0.0005). Among those presenting