Angiogenic biomarkers for prediction of maternal and neonatal complications in suspected preeclampsia

Abstract

Objective: To determine if maternal serum angiogenic factors predict maternal and neonatal complications in women presenting to an acute care setting with suspected preeclampsia. Study design: Maternal serum samples were prospectively collected from women with suspected preeclampsia at the time of initial presentation to hospital triage with signs or symptoms of preeclampsia. Soluble fms-like tyrosine kinase-1 (sFlt1), placental growth factor (PlGF), and soluble endoglin (sEng) were measured by ELISA. The primary outcome was a composite of maternal and neonatal complications. Results: Of 276 women with suspected preeclampsia, 78 developed maternal or neonatal complications. Among women presenting prior to 37 weeks gestation, sFlt1, PlGF, and sEng were significantly different in women who developed maternal and neonatal complications as compared to women without complications. Higher levels of sFlt1, sEng, and the sFlt1:PlGF ratio were associated with an increased odds of complications among women presenting prior to 37 weeks. A multivariable model combining the sFlt1:PlGF ratio with clinical variables was more predictive of complications (AUC 0.91, 95% CI 0.85–0.97) than a model using clinical variables alone (AUC 0.82, 95% CI 0.79–0.90). Conclusion: Angiogenic biomarkers associate with maternal and neonatal complications in women with suspected preeclampsia, and may be useful for risk stratification.

Keywords::

• Angiogenic factors
• placental growth factor
• preeclampsia
• sFlt1
• soluble endoglin

Acknowledgements

We thank Melissa J. Moore, Ph.D., (Professor, Dept. of Biochemistry and Molecular Pharmacology, University of Massachusetts Medical School; Investigator, Howard Hughes Medical Institute) for assistance with angiogenic factor assays. We thank our reviewers for helpful comments and suggestions.

Declaration of Interest: This work was supported by a Grant-in-Aid from the National Kidney Foundation of the National Capital Area, and by the Wilson Genetics Endowment of the George Washington University School of Medicine and Health Sciences. Andreea Moore was supported by a grant from the Alpha Omega Alpha Medical Honor Society. Sharon Maynard is co-inventor on a patent held by Beth Israel Deaconess Medical Center for the use of angiogenic factors for screening and treatment of preeclampsia. No other authors have a conflict of interest.