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Jaatinen N, Ekholm E, Laivuori FH, Jääskeläinen T. Impact of physical activity on preeclampsia and angiogenic markers in the Finnish Genetics of Pre-eclampsia Consortium (FINNPEC) cohort. Ann Med 2024; 56:2325480. [PMID: 38466911 DOI: 10.1080/07853890.2024.2325480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 02/23/2024] [Indexed: 03/13/2024] Open
Abstract
INTRODUCTION Effect of physical activity in pregnancy on preeclampsia (PE) and angiogenic markers is not well understood. We studied the association of physical activity and PE in a case-control setting and assessed whether exercise in PE and non-PE women associate with maternal serum concentrations of soluble fms-like tyrosine kinase 1 (s-Flt-1), placental growth factor (PlGF) and soluble endoglin (sEng) and sFlt-1/PlGF ratio in the Finnish Genetics of Pre-eclampsia Consortium (FINNPEC) cohort. MATERIALS AND METHODS Participants completed a questionnaire on their background information and serum samples were collected from a subset. Questionnaire data on physical activity were available from 708 PE women and 724 non-PE women. Both first trimester serum samples and questionnaire data on physical activity were available from 160 PE women and 160 non-PE women, and second/third trimester serum samples and questionnaire data on physical activity were available from 139 PE women and 47 non-PE women. The PE and non-PE women were divided into categories of physically active (exercise 2 - 3 times/week or more) and physically inactive (exercise less than 2 - 3 times/week). RESULTS A total of 43.4% of the PE women and 42.4% of the non-PE women were categorized as physically active. There were no differences in physical activity and exercise habits between the groups. The physically active women were more often nulliparous and non-smokers and had a lower body mass index. There were no differences in the concentrations of angiogenic markers (sFlt-1, PlGF and sEng and sFlt-1/PlGF ratio) between the groups who exercised more or less than 2 - 3 times/week. CONCLUSIONS In the FINNPEC study cohort, there was no association between physical activity and PE and no associations of physical activity in pregnant women with and without PE with maternal serum concentrations of sFlt-1, PlGF and sEng and sFlt-1/PlGF ratio.
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Affiliation(s)
- Noora Jaatinen
- Department of Obstetrics and Gynecology, Turku University Central Hospital and University of Turku, Turku, Finland
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Eeva Ekholm
- Department of Obstetrics and Gynecology, Turku University Central Hospital and University of Turku, Turku, Finland
| | - Finnpec Hannele Laivuori
- Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Technology, Center for Child, Adolescent, and Maternal Health Research, Tampere University Hospital and University of Tampere, Tampere, Finland
| | - Tiina Jääskeläinen
- Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
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Lau KGY, Kountouris E, Salazar-Rios L, Nicolaides KH, Kametas NA. Prediction of adverse outcome by ophthalmic artery Doppler and angiogenic markers in pregnancies with new onset hypertension. Pregnancy Hypertens 2023; 34:110-115. [PMID: 37925874 DOI: 10.1016/j.preghy.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 07/31/2023] [Accepted: 10/06/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES To compare the ophthalmic artery Doppler peak systolic velocity ratio (OA PSV-ratio) and soluble fms-like tyrosine kinase-1/placental growth factor ratio (sFlt-1/PlGF ratio) in predicting adverse maternal and perinatal outcomes in women presenting with new onset hypertension. STUDY DESIGN Prospective cohort study in a specialist hypertension clinic, within a tertiary referral centre. MAIN OUTCOME MEASURES Comparison between the OA PSV-ratio and sFlt-1/PlGF ratio in predicting delivery within one week from presentation and adverse maternal and perinatal outcomes e.g. severe hypertension, neonatal unit admission, small for gestational age. RESULTS Women who delivered within one week, compared to those who did not, had a higher OA PSV-ratio (0.82 vs 0.71, p < 0.01) and sFlt-1/PlGF ratio (93.3 vs 40.5, p = 0.08). Independent predictors of the OA PSV-ratio included mean arterial pressure and maternal weight and predictors of the sFlt-1/PlGF ratio included diastolic blood pressure and use of antihypertensive medications. Prediction of adverse outcomes with both ratios were similar and only modest e.g. AUROC for predicting delivery within one week for OA PSV-ratio was 0.57 (95% CI 0.47-0.67) and for sFlt-1/PlGF ratio was 0.61 (95% CI 0.52-0.70) (p = 0.53). CONCLUSIONS In women presenting with new onset hypertension, the OA PSV-ratio and sFlt-1/PlGF ratio have similar and modest performance in predicting adverse outcomes.
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Affiliation(s)
- Katherine G Y Lau
- Antenatal Hypertension Clinic, King's College Hospital, London, UK; Harris Birthright, Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | | | | | - Kypros H Nicolaides
- Harris Birthright, Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - Nikos A Kametas
- Antenatal Hypertension Clinic, King's College Hospital, London, UK; Harris Birthright, Research Centre for Fetal Medicine, King's College Hospital, London, UK.
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Li JW, Wang JY, Yu RQ, Huo L, Zheng LW. Expression of angiogenic markers in jawbones and femur in a rat model treated with zoledronic acid. BMC Res Notes 2022; 15:12. [PMID: 35012647 PMCID: PMC8751108 DOI: 10.1186/s13104-021-05900-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/23/2021] [Indexed: 11/22/2022] Open
Abstract
Objectives This study aimed to investigate the gene expression of angiogenic marker in surgically treated jawbones and femur on a rat model administrated with zoledronic acid. Results No soft tissue fenestration or bone exposure was found in femur. Delayed soft tissue healing was found in both ZA group (3 in mandible, 4 in maxilla) and control group (1 in mandible, 2 in maxilla), while exposed bone was found only in the ZA group (1 in maxilla, 2 in mandible). RT-PCR analysis demonstrated no significant difference in gene expression of angiogenetic markers between ZA-treated and control groups in femur and mandible. In the maxilla, the expression of VEGFA and VEGFR-2 in medium-term ZA group was significantly down-regulated compared with that in the control. The ZA treatment does not change significantly the expression of the angiogenic factors in femur and mandible, but significantly downregulates the expression in maxilla in this rat model. The angiogenesis inhibition may contribute to the development of MRONJ but does not play a key role. Supplementary Information The online version contains supplementary material available at 10.1186/s13104-021-05900-5.
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Affiliation(s)
- Jing Wen Li
- Discipline of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Jing Yi Wang
- Discipline of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Ru Qing Yu
- Discipline of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Lei Huo
- Department of Orthodontics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Li Wu Zheng
- Discipline of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.
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Reljič M, Porović A. Maternal serum levels of angiogenic markers and markers of placentation in pregnancies conceived with fresh and vitrified-warmed blastocyst transfer. J Assist Reprod Genet 2019; 36:1489-1495. [PMID: 31104293 DOI: 10.1007/s10815-019-01484-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 05/09/2019] [Indexed: 12/11/2022] Open
Abstract
PURPOSE The aim of the study was to compare the levels of angiogenic markers and markers of placentation between pregnancies conceived with fresh (ET) and vitrified-warmed blastocyst transfer (FET). METHODS Women with singleton pregnancies resulting from fresh ET or FET during the period between 2013 and 2017 were included in this prospective observational study. Fresh ET was performed in a stimulated and FET in natural cycle. At 6-7 weeks of gestation, after ultrasound confirmation of a single gestational sac with a viable embryo, serum levels of free β-hCG, pregnancy-associated plasma protein A (PAPP-A), placental growth factor (PIGF) and fms-like tyrosine kinase (sFlt-1) were measured. Data on the patients' characteristics, pregnancy complications and outcomes were collected from a questionnaire and National Perinatal Information System of Slovenia. RESULTS Among 211 pregnancies, 126 were achieved with fresh ET and 85 with FET. There were no significant differences in perinatal outcome, pregnancy complication and PIGF level between the fresh ET and FET group. Women achieving pregnancy with FET had significant higher levels of free β-hCG (40.20 ± 30.62 IU/L vs. 28.74 ± 23.52, p = 0.002), PAPP-A (0.09 ± 0.06 vs. 0.06 ± 0.05 IU/L, p = 0.004) and sFlt-1 (596.19 ± 283.06 vs. 436.53 ± 248.23 pg/L, p < 0.0001) compared to women having conceived with fresh ET. There were no significant differences in the levels of evaluated biomarkers between patients with different pregnancy outcomes and complications. CONCLUSION Levels of angiogenic markers and markers of placentation differ between pregnancies achieved with fresh ET and FET which may reflect altered implantation and early placentation with some forms of assisted reproductive technologies.
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Affiliation(s)
- Milan Reljič
- Department of Reproductive Medicine and Gynaecologic Endocrinology, Division of Gynaecology and Perinatology, University Medical Centre Maribor, Ljubljanska 5, 2000, Maribor, Slovenia.
| | - Admir Porović
- Department of Gynaecology and Perinatology, Academic HELIOS Hospital Köthen, University Martin-Luther Halle-Wittenberg, Hallesche Str. 29, 06366, Köthen (Anhalt), Germany
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Rapanotti MC, Franceschini L, Viguria TMS, Ialongo C, Fraboni D, Cerretti R, De Angelis G, Pupo L, Rizzo M, Cantonetti M, Postorino M, Voso MT, Lo-Coco F. Molecular Expression of Bone Marrow Angiogenic Factors, Cell-Cell Adhesion Molecules and Matrix-Metallo-Proteinases in Plasmacellular Disorders: a Molecular Panel to İnvestigate Disease Progression. Mediterr J Hematol Infect Dis 2018; 10:e2018059. [PMID: 30416691 DOI: 10.4084/MJHID.2018.059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 09/19/2018] [Indexed: 12/18/2022] Open
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Jääskeläinen T, Suomalainen-König S, Hämäläinen E, Pulkki K, Romppanen J, Heinonen S, Laivuori H. Angiogenic profile and smoking in the Finnish Genetics of Pre-Eclampsia Consortium (FINNPEC) cohort. Ann Med 2017; 49:593-602. [PMID: 28537456 DOI: 10.1080/07853890.2017.1335427] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES The biological mechanism by which smoking reduces the risk of pre-eclampsia (PE) is unresolved. We studied serum levels of soluble fms-like tyrosine kinase 1 (sFlt-1), placental growth factor (PlGF) and their ratio, in addition to soluble endoglin (sEng) in early and late pregnancy to ascertain whether these factors are altered in women who smoke. SUBJECTS AND METHODS First trimester serum samples were available from 217 women who later developed PE and 238 women who did not develop PE. Second/third trimester serum samples were available from 174 PE and 54 non-PE women. RESULTS PE women who smoked during pregnancy had elevated first trimester concentrations of serum PlGF [geometric mean (95% CI): 39.8 (32.6-48.5) pg/ml, p = .001] and reduced sEng concentration [5.0 (4.6-5.6) ng/ml, p = .047] compared to PE non-smokers [30.0 (28.1-32.1) pg/ml and 6.1 (5.9-6.4) ng/ml, respectively]. Non-smoking women in the PE group had the highest sFlt-1/PlGF ratio in early and late pregnancy. CONCLUSIONS The protective effect of smoking in reducing the risk of PE may be due to the early pregnancy change towards pro-angiogenic marker profile. Also, in late pregnancy, smoking exerted effect in sFlt-1/PlGF ratio in PE pregnancies, and may complicate its use as a prognostic and diagnostic marker. Key messages Smoking appears to have angiogenic effects in early pregnancy with reduced sEng concentrations and elevated PlGF concentrations in both normal and PE pregnancies. Throughout pregnancy, smoking exerted effect in PlGF concentration and sFlt-1/PlGF ratio in PE pregnancies, and thus may complicate its use as a prognostic and diagnostic marker.
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Affiliation(s)
- Tiina Jääskeläinen
- a Medical and Clinical Genetics , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Sanna Suomalainen-König
- a Medical and Clinical Genetics , University of Helsinki and Helsinki University Hospital , Helsinki , Finland.,b Obstetrics and Gynecology , University of Helsinki and Helsinki University Hospital , Helsinki, Finland
| | - Esa Hämäläinen
- c HUSLAB , Helsinki University Hospital and University of Helsinki , Helsinki , Finland
| | - Kari Pulkki
- d Eastern Finland Laboratory Centre and Department of Clinical Chemistry , University of Eastern Finland , Kuopio , Finland
| | - Jarkko Romppanen
- d Eastern Finland Laboratory Centre and Department of Clinical Chemistry , University of Eastern Finland , Kuopio , Finland
| | - Seppo Heinonen
- b Obstetrics and Gynecology , University of Helsinki and Helsinki University Hospital , Helsinki, Finland
| | - Hannele Laivuori
- a Medical and Clinical Genetics , University of Helsinki and Helsinki University Hospital , Helsinki , Finland.,b Obstetrics and Gynecology , University of Helsinki and Helsinki University Hospital , Helsinki, Finland.,e Institute for Molecular Medicine Finland/HiLIFE , University of Helsinki , Helsinki , Finland
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Woo I, Chan Y, Sriprasert I, Louie K, Ingles S, Stanczyk F, McGinnis LK, Chung K. The role of angiogenic markers in adverse perinatal outcomes: fresh versus frozen embryo transfers. J Assist Reprod Genet 2017; 34:1639-1643. [PMID: 28871422 DOI: 10.1007/s10815-017-1023-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 08/11/2017] [Indexed: 02/05/2023] Open
Abstract
PURPOSE We aimed to investigate the angiogenic balance in fresh compared to frozen embryo transfers, and among neonates with adverse perinatal outcomes. METHODS This was a retrospective cohort study. All IVF cycles resulting in a singleton live birth at a university academic fertility center from January 1, 2011, to December 31, 2013, were examined. Concentrations of sFLT-1 and PlGF were measured in previously frozen serum specimens collected during early gestation at approximately 5 weeks gestation. Patients completed an electronic survey to detail perinatal outcome. RESULTS We identified 152 singleton live births (103 fresh, 49 frozen). Demographic characteristics were similar between the two groups. Ratios of sFlt-1:PlGF were not different between fresh and frozen transfers. Neonates from fresh cycles had a mean birth weight 202 g lighter (p = 0.01) than frozen cycles, after adjusting for gestational age. Among babies born with poor perinatal outcomes, there was a difference in sFlt-1:PlGF ratios after adjusting for race. In non-Asians, infants born small for gestational age (SGA) (< 10th percentile) had significantly higher sFLT-1:PLGF ratio, median ratio (0.21 vs 0.12, p = 0.016). CONCLUSIONS Fresh transfers were associated with lower birth weight infants compared to frozen transfers. While there was no difference in sFlt-1:PlGF ratios between fresh and frozen transfers, these ratios were significantly lower in SGA infants, suggesting an imbalance in angiogenic markers during placentation.
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Affiliation(s)
- Irene Woo
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, University of Southern California, Los Angeles, CA, USA. .,Department of Obstetrics and Gynecology, LAC+USC Medical Center, University of Southern California, 2020 Zonal Avenue IRD 534, Los Angeles, CA, 90033, USA.
| | - Yen Chan
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine Keck School of Medicine, University of Southern California, 2020 Zonal Avenue, Los Angeles, CA, 90033, USA
| | - Intira Sriprasert
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, University of Southern California, Los Angeles, CA, USA.,Department of Obstetrics and Gynecology, Division of Reproductive Health, Chiang Mai University, Chiang Mai, Thailand
| | - Kristin Louie
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, University of Southern California, Los Angeles, CA, USA
| | - Sue Ingles
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, University of Southern California, Los Angeles, CA, USA
| | - Frank Stanczyk
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, University of Southern California, Los Angeles, CA, USA
| | - Lynda K McGinnis
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, University of Southern California, Los Angeles, CA, USA
| | - Karine Chung
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, University of Southern California, Los Angeles, CA, USA
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Vinayagam V, Bobby Z, Habeebullah S, Chaturvedula L, Bharadwaj SK. Maternal and Cord Blood Plasma sEng and TGF-β1 in Patients with Hypertensive Disorders of Pregnancy: A Pilot Study in a South Indian Population. J Clin Diagn Res 2017; 11:QC32-QC34. [PMID: 28511458 DOI: 10.7860/jcdr/2017/22790.9600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 08/31/2016] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Hypertensive Disorders of Pregnancy (HDP) are one of the most widespread complications of pregnancy that affects both mother and foetus. It has been observed that in Preeclampsia, the release of soluble angiogenic factors from the ischemic placenta into maternal plasma plays a crucial role in the pathogenesis. AIM To assess the plasma Soluble Endoglin (sEng) and Transforming Growth Factor (TGF-β1) levels in various types of HDP and to correlate the levels of these markers with the pregnancy outcome. MATERIALS AND METHODS A total of 128 pregnant women were recruited and the study was carried out for a period of three years. Cord blood and maternal blood plasma levels of sEng and TGF-β1 were analysed by ELISA kits in Control Pregnant Women (CPW), Gestational Hypertension (GH), Early Onset Preeclampsia (EOPE), Late Onset Preeclampsia (LOPE), and Eclampsia (E) during third trimester. The Gestational Age (GA) at the time of delivery and Birth Weight (BW) of the baby also were also evaluated. RESULTS The circulating levels of maternal and cord blood sEng were significantly higher in EOPE and E compared to CPW and GH. However, the maternal and cord blood levels of TGF-β1 were significantly lower in LOPE and E when compared to CPW and GH. The GA and BW of the baby were found to be significantly lower in EOPE and E compared to CPW, GH and LOPE. Also, a negative correlation was observed between sEng levels with pregnancy outcome; GA and BW. And also, a positive correlation was found between TGF-β1 and pregnancy outcome. CONCLUSION A generalised angiogenic imbalance and poor birth outcomes were observed in HDP. There is a spectrum of biochemical derangements related to angiogenesis in GH, EOPE, LOPE and E.
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Affiliation(s)
- Vickneshwaran Vinayagam
- Ph D Scholar, Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Zachariah Bobby
- Professor and Head, Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Syed Habeebullah
- Professor, Department of Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Latha Chaturvedula
- Professor, Department of Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Shruthi K Bharadwaj
- Student (DM Neonatology), Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
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Di Martino D, Cetin I, Frusca T, Ferrazzi E, Fuse' F, Gervasi MT, Plebani M, Todros T. Italian Advisory Board: sFlt-1/PlGF ratio and preeclampsia, state of the art and developments in diagnostic, therapeutic and clinical management. Eur J Obstet Gynecol Reprod Biol 2016; 206:70-73. [PMID: 27639603 DOI: 10.1016/j.ejogrb.2016.08.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 08/14/2016] [Accepted: 08/19/2016] [Indexed: 12/20/2022]
Abstract
Extensive research has been published, showing the usefulness of angiogenic markers in both diagnosis and subsequent prediction and management of preeclampsia and placenta-related disorders. Recent evidence provides a helpful cut off for the Elecsys ratio sFlt-1 to PlGF, that predicts preeclampsia development in women with sign and symptoms, before its clinical onset in the short term. In Europe, no accordance exists for the use of such kind of test in clinical practice; only German guidelines have recently taken it into account, as a diagnostic aid for preeclampsia, in conjunction with other clinical findings. This panel of Italian experts recently met, in order to review the literature and to promote the evaluation of the clinical utility of sFlt-1/PlGF ratio at the Italian country level, as regards: prediction of preeclampsia during the first trimester, prediction or exclusion of new onset or recurrence in patients with risk factors for preeclampsia, triage of patients suffering from gestational hypertension, evaluation of disease severity, prediction of adverse maternal and fetal outcomes.
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Affiliation(s)
- Daniela Di Martino
- Department of Woman, Mother and Neonate, Buzzi Children's Hospital, Biomedical and Clinical Sciences, School of Medicine, University of Milan, Milan, Italy.
| | - Irene Cetin
- Department of Mother and Child, Hospital Luigi Sacco, Center for Fetal Research "Giorgio Pardi", School of Medicine, University of Milan, Milan, Italy
| | - Tiziana Frusca
- Department of Mother and Child, Hospital of Parma, School of Medicine, University of Parma, Parma, Italy
| | - Enrico Ferrazzi
- Department of Woman, Mother and Neonate, Buzzi Children's Hospital, Biomedical and Clinical Sciences, School of Medicine, University of Milan, Milan, Italy
| | - Federica Fuse'
- Department of Woman, Mother and Neonate, Buzzi Children's Hospital, Biomedical and Clinical Sciences, School of Medicine, University of Milan, Milan, Italy
| | | | - Mario Plebani
- Department of Laboratory Medicine, Hospital of Padova, Padova, Italy
| | - Tullia Todros
- Department of Mother and Fetus, Hospital of Turin, Obstetrics and Gynecology Unit, School of Medicine, University of Turin, Turin, Italy
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Myers JE, Kenny LC, McCowan LME, Chan EHY, Dekker GA, Poston L, Simpson NAB, North RA. Angiogenic factors combined with clinical risk factors to predict preterm pre-eclampsia in nulliparous women: a predictive test accuracy study. BJOG 2013; 120:1215-23. [PMID: 23906160 DOI: 10.1111/1471-0528.12195] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2013] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To assess the performance of clinical risk factors, uterine artery Doppler and angiogenic markers to predict preterm pre-eclampsia in nulliparous women. DESIGN Predictive test accuracy study. SETTING Prospective multicentre cohort study Screening for Pregnancy Endpoints (SCOPE). METHODS Low-risk nulliparous women with a singleton pregnancy were recruited. Clinical risk factor data were obtained and plasma placental growth factor (PlGF), soluble endoglin and soluble fms-like tyrosine kinase-1 (sFlt-1) were measured at 14-16 weeks of gestation. Prediction models were developed using multivariable stepwise logistic regression. MAIN OUTCOME MEASURE Preterm pre-eclampsia (delivered before 37(+0) weeks of gestation). RESULTS Of the 3529 women recruited, 187 (5.3%) developed pre-eclampsia of whom 47 (1.3%) delivered preterm. Controls (n = 188) were randomly selected from women without preterm pre-eclampsia and included women who developed other pregnancy complications. An area under a receiver operating characteristic curve (AUC) of 0.76 (95% CI 0.67-0.84) was observed using previously reported clinical risk variables. The AUC improved following the addition of PlGF measured at 14-16 weeks (0.84; 95% CI 0.77-0.91), but no further improvement was observed with the addition of uterine artery Doppler or the other angiogenic markers. A sensitivity of 45% (95% CI 0.31-0.59) (5% false-positive rate) and post-test probability of 11% (95% CI 9-13) were observed using clinical risk variables and PlGF measurement. CONCLUSIONS Addition of plasma PlGF at 14-16 weeks of gestation to clinical risk assessment improved the identification of nulliparous women at increased risk of developing preterm pre-eclampsia, but the performance is not sufficient to warrant introduction as a clinical screening test. These findings are marker dependent, not assay dependent; additional markers are needed to achieve clinical utility.
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Affiliation(s)
- J E Myers
- Faculty of Medical and Human Sciences, Maternal & Fetal Heath Research Centre, Institute of Human Development, Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, University of Manchester, UK.
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