Late-onset preeclampsia is associated with an imbalance of angiogenic and anti-angiogenic factors in patients with and without placental lesions consistent with maternal underperfusion

Figures & data

Table I.  Clinical and obstetrical characteristics of the study population.

	Uncomplicated pregnancy	Preeclampsia without placental lesions of underperfusion	Preeclampsia with placental lesions of underperfusion
	(n = 64)	(n = 35)	(n = 31)
Maternal age (y)	27 (22–30)	21 (18–27)*	24 (20–30)
Nulliparity	11 (17.2)	21 (60)	20 (64.5)
Smoking	14 (21.9)	5 (14.3)	6 (19.4)
Gestational age at venipuncture (wks)	39.1 (38.3–39.4)	37.7 (36.5–39)*	38.4 (36–39.8)
Severe preeclampsia	0	31 (88.6)	26 (83.9)
Gestational age at delivery (wks)	39.1 (38.8–39.8)	37.8 (36.5–39)*	38.5 (36–39.8)*
Birthweight (g)	3342 (3152–3622)	2790 (2380–3210)*^μ	2650 (2060–2880)*^μ
SGA (BW <10%)	0	13 (37.1)	20 (64.5)
Male neonates	35 (54.7)	18 (51.4)	13 (41.9)

Values expressed as median (interquartile range) or number (percent). *p < 0.05 when compared to normal pregnancy.^μp < 0.05 when compared to late-onset preeclampsia without underperfusion placental lesions.

SGA: Small for gestational age; BW: Birthweight.

Figure 1.  Maternal plasma concentration of PlGF between women with an uncomplicated pregnancy and women with late-onset PE with and without underperfused placental lesions. Women with late-onset PE without underperfused placental lesions had a lower median plasma PlGF concentration than women with uncomplicated pregnancies. Similarly, women with late-onset PE with underperfused placental lesions had a lower median plasma PlGF concentration than women with uncomplicated pregnancies. Among women with late-onset PE, those who had underperfused placental lesions had a lower median plasma PlGF concentration than those without these lesions.

Figure 2.  Maternal plasma PlGF/sVEGFR-1 ratio between women with an uncomplicated pregnancy and women with late-onset PE with and without underperfused placental lesions. Women with late-onset PE without underperfused placental lesions had a lower median plasma PlGF/sVEGFR-1 ratio than women with uncomplicated pregnancies. Similarly, women with late-onset PE with underperfused placental lesions had a lower median plasma PlGF/sVEGFR-1 ratio than women with uncomplicated pregnancies. Among women with late-onset PE, those with underperfused placental lesions had a lower median plasma PlGF/sVEGFR-1 ratio than women with late- onset PE without evidence of underperfused placental lesions.

Figure 3.  Maternal plasma PlGF/sEng ratio between women with an uncomplicated pregnancy and women with late-onset PE with and without underperfused placental lesions. Women with late-onset PE without underperfused placental lesions had a lower median plasma PlGF/sEng ratio than women with uncomplicated pregnancies. Similarly, women with late-onset PE with underperfused placental lesions had a lower median plasma PlGF/sEng ratio than women with uncomplicated pregnancies. Among women with late-onset PE, those with underperfused placental lesions had a lower median plasma PlGF/sEng ratio than women with late-onset PE without evidence of underperfused placental lesions.

Figure 4.  Maternal median plasma concentration of sEng between women with an uncomplicated pregnancy and women with late-onset PE with and without underperfused placental lesions. Women with late-onset PE without underperfused placental lesions had a higher median plasma sEng than women with uncomplicated pregnancies. Similarly, women with late-onset PE with underperfused placental lesions had a higher median plasma sEng than women with uncomplicated pregnancies. In contrast, there was no difference in the median plasma sEng between women with late-onset PE with or without underperfused placental lesions.

Figure 5.  Maternal median plasma concentration of sVEGFR-1 between women with an uncomplicated pregnancy and women with late-onset PE with and without underperfused placental lesions. Women with late-onset PE without underperfused placental lesions had a higher median plasma sVEGFR-1 than women with uncomplicated pregnancies. Similarly, women with late-onset PE with underperfused placental lesions had a higher median plasma sVEGFR-1 than women with uncomplicated pregnancies. In contrast, there was no difference in the median plasma sVEGFR-1 between women with late-onset PE with or without underperfused placental lesions.

Figure 6.  Maternal median plasma concentration of sVEGFR-2 between women with an uncomplicated pregnancy and women with late-onset PE with and without underperfused placental lesions. Women with late-onset PE without underperfused placental lesion had higher median plasma sVEGFR-2 than women with uncomplicated pregnancies. In contrast, there was no difference in the median plasma concentration of sVEGFR-2 between women with late-onset PE with underperfused placental lesions women with uncomplicated pregnancies. There was no difference in the median plasma sVEGFR-2 between women with late-onset PE with or without underperfused placental lesion.

Table II.  Maternal plasma concentration of angiongenic and anti-angiogenic factors in the study population.

	Uncomplicated pregnancy	Preeclampsia without placental lesions of underperfusion	Preeclampsia with placental lesions of underperfusion
	(n = 64)	(n = 35)	(n = 31)
PlGF (pg/ml)	348.8 (196.3–729.3)	128.9 (85–212)^†	90 (68–137)*^†
PlGF/sVEGFR-1	0.23 (0.11–0.43)	0.029 (0.020–0.048)^†	0.017 (0.10–0.26)*^†
PlGF/sEng	49.2 (17.2–96)	6.7 (1.9–13.1)^†	2.3 (1.5–6)*^†
sEng (ng/ml)	8.1 (6.1–12.5)	20.6 (12–40.7)^†	35.5 (15–49.2)^†
sVEGFR-1 (pg/ml)	1635 (1150–2138)	3995 (3058–5679)^†	5314 (3404–8231)^†
sVEGFR-2 (ng/ml)	9.2 (7.4–11.2)	7 (5.4–8.5)^†	7.5 (5.6–10.5)

Values expressed as median (interquartile range).PE: Preeclampsia; PlGF: placental growth factor; sEng: soluble endoglin;sVEGFR-1: soluble vascular endothelial growth factor receptor 1.sVEGFR-2: soluble vascular endothelial growth factor receptor 2. *p Value <0.05 when compared to late-onset PE without placental lesions of underperfusion. ^†p Value <0.01 when compared to normal pregnancy.