Sequential Plasma Angiogenic Factors Levels in Women with Suspected Preeclampsia

Abstract Background Alterations in circulating angiogenic factors are associated with the diagnosis of preeclampsia and correlate with adverse perinatal outcomes during the third trimester. Objective Analysis of the sequential levels of plasma angiogenic factors among patients admitted for evaluation of preeclampsia. Study Design We performed an observational study among women with singleton pregnancies admitted to Beth Israel Deaconess Medical center, Boston, MA for evaluation of preeclampsia at less than 37 weeks gestation. Discarded plasma samples were collected upon admission and daily for the first three days and then weekly till delivery. Doppler ultrasound was performed upon admission (within 48 hours) and then weekly (within 24 hours of blood collection) to evaluate uteroplacental and umbilical blood flows. Maternal demographics, hospital course, mode of delivery, diagnosis of hypertensive disorder, adverse maternal outcomes (elevated liver function enzymes, low platelet count, pulmonary edema, cerebral hemorrhage, convulsion, acute renal insufficiency, or maternal death), and adverse fetal/neonatal outcomes (small for gestational age, abnormal umbilical artery Doppler, fetal death, and neonatal death) were recorded. Circulating angiogenic factors (soluble fms like tyrosine kinase – sFlt1 and placental growth factor – PlGF) were measured on automated platform in a single batch after delivery and in a blinded fashion. Data is presented as median (25th -75th centile), mean or proportions as appropriate. Results During the study period, data from 100 women were analyzed for the study and 43 had adverse outcomes. Women with adverse outcomes had lower gestational age of delivery, higher systolic and diastolic blood pressures during hospitalization, lower birth weight and placental weight (all P