Low Placental Growth Factor Across Pregnancy Identifies a Subset of Women With Preterm Preeclampsia Type 1 Versus Type 2 Preeclampsia?

Department of Obstetrics, Gynecology, and Reproductive SciencesMagee-Womens Research Institute, University of Pittsburgh, Pittsburgh, PA, USA.
Hypertension (Impact Factor: 6.48). 05/2012; 60(1):239-46. DOI: 10.1161/HYPERTENSIONAHA.112.191213
Source: PubMed

ABSTRACT Preeclampsia is a heterogeneous syndrome affecting 3% to 5% of all pregnancies. An imbalance of the antiangiogenic and proangiogenic factors, soluble receptor fms-like tyrosine kinase 1 and placental growth factor (PGF), is thought to contribute to the pathophysiology of preeclampsia. Maternal plasma PGF and soluble receptor fms-like tyrosine kinase 1 were quantified by specific immunoassays in cross-sectional samples from 130 preeclamptic subjects and 342 normotensive controls at delivery and longitudinally in samples from 50 women who developed preeclampsia and 250 normotensive controls. Among women who developed preeclampsia, 46% (n=23) evidenced a pattern of consistently low maternal PGF across pregnancy below the lower 95% CI of controls from 15 weeks' gestation to term. In contrast, the remaining 54% (n=27) of women who developed preeclampsia had maternal PGF concentrations similar to or above (n=7) those of normotensive controls. Subjects with low PGF across pregnancy who developed preeclampsia evidenced significantly higher blood pressure in early pregnancy (P<0.05) and, after diagnosis, earlier gestational age at delivery (P<0.05) and more preterm birth (P<0.05) compared with preeclamptic patients with high PGF. A significant subset of women who develop preeclampsia show evidence of consistently low PGF across pregnancy. Low PGF with preeclampsia was associated with preterm delivery compared with preeclamptic patients with high PGF. Identifying women with consistently low plasma PGF during pregnancy may provide a greater understanding of preeclampsia pathophysiology and may provide more focused research and clinical activities.

7 Reads
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We sought to determine whether haptoglobin (Hp) phenotype is related to preeclampsia risk, or to plasma concentrations of soluble endoglin (sEng), soluble fms-like tyrosine kinase 1 (sFlt-1), and placental growth factor (PlGF). Hp phenotype was retrospectively determined in primiparous women with uncomplicated pregnancies (n = 309), gestational hypertension (n = 215), and preeclampsia (n = 249). Phenotype was assessed by peroxidase staining following native polyacrylamide gel electrophoresis of hemoglobin-supplemented serum. Compared with Hp 1-1, Hp 2-1 was associated with a significantly increased risk of preeclampsia (odds ratio, 2.11; 95% confidence interval, 1.07-4.18) and term preeclampsia (odds ratio, 2.45; 95% confidence interval, 1.07-5.83) in Caucasian women. Hp phenotype was not associated with preeclampsia risk in African Americans. Preeclamptic women had higher plasma sEng and sFlt-1, and lower PlGF, than control subjects. sEng, sFlt-1, and PlGF did not differ among women of different Hp phenotypes. Hp 2-1 is associated with higher preeclampsia risk in primiparous Caucasian women.
    American journal of obstetrics and gynecology 01/2012; 206(4):358.e10-8. DOI:10.1016/j.ajog.2012.01.009 · 4.70 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this study was to analyze whether maternal serum placental growth factor (PlGF) could predict early onset preeclampsia (<32 weeks of gestation) in overweight/obese pregnant women, and whether it could do it more effectively than in normal/underweight pregnant women. A prospective cohort study was conducted on 1678 pregnant women with singleton pregnancies, who were grouped as underweight, normal, overweight, and obese on the basis of body mass index, followed by serum PlGF estimation at 20 to 22 weeks of gestation. A cut-off value of <144 pg/mL for PlGF was determined by Receiver Operating Characteristic curve analysis to identify risk of early onset preeclampsia. Univariate logistic regression analysis revealed significantly stronger association between PlGF <144 pg/mL and early onset preeclampsia in overweight/obese pregnant women (odds ratio 7.64; 95% confidence interval 5.34-10.12; P = .000) than in normal/underweight pregnant women (odds ratio 2.95; 95% confidence interval 1.74-4.26; P = .007). Weight and PlGF levels in study women had a significant negative correlation (r = 0.663; P = .002). Serum PlGF in early second trimester could be an effective predictor of early onset preeclampsia in overweight/obese pregnant women and may be more effective than in normal/underweight pregnant women.
    Journal of the American Society of Hypertension (JASH) 02/2013; DOI:10.1016/j.jash.2012.12.006 · 2.61 Impact Factor
  • Source
    Hypertension 03/2013; 61(5). DOI:10.1161/HYPERTENSIONAHA.111.00250 · 6.48 Impact Factor
Show more