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Grand Rounds

Is Urinary PlGF Associated with Preeclampsia?

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BACKGROUND AND PURPOSE:

  • Low levels of serum placental growth factor (PlGF) in pregnancy are associated with preeclampsia
  • Lecarpentier et al. (Obstetrics & Gynecology, 2019) sought to determine whether urinary levels of PlGF during pregnancy are associated with adverse outcomes composite adverse outcomes <34 weeks of gestation

METHODS:

  • Ancillary study of the randomized Heparin-Preeclampsia trial
  • Participants
    • Pregnant women with early-onset (<34 weeks) preeclampsia
  • In the parent study
    • All women were treated with aspirin
    • Randomized to and then randomized to receive either low-molecular-weight heparin (LMWH) or aspirin
  • In this substudy
    • Urinary levels of PlGF and urinary creatinine were measured at 10w0d to 13w6d | 14w0d to 17w6d | 18w0d to 21w6d | 22w0d to 25w6d | 26w0d to 29w6d | 30w0d to 33w6d | 34w0d to 37w6d
  • Primary outcome
    • Composite of adverse pregnancy outcomes: Preeclampsia | FGR | Placental abruption | Perinatal death | Maternal death
  • For the prediction analysis
    • Mid-pregnancy samples were used (22 to 26 weeks) from those women who went on to develop either (1) composite adverse outcomes or preeclampsia <34 weeks and compared to those who did not develop these adverse events

RESULTS:

  • Urine samples were taken from 187 patients
    • LMWH plus aspirin (n=93) | Aspirin alone (n=94)
    • There was not difference between the groups for the following
      • Adverse composite outcomes <34 weeks | Urinary PlGF levels
  • Median urinary PlGF/creatinine concentrations (pg/mg) measured at mid-pregnancy (22–26 weeks of gestation) were significantly lower
    • For women who developed composite adverse outcome <34 weeks of gestation (P<0.001)
      • Developed composite outcome: 42.7
      • Did not develop composite outcome: 255.6
    • For women who developed preeclampsia <34 weeks (P<0.001)
      • Developed preeclampsia: 42.7
      • Did not develop preeclampsia <34 weeks: 244.6
  • Sensitivity at 22 to 26 weeks (false positive rate of 10%)
    • For development of composite adverse outcomes <34 weeks: 75.2% (area under the curve 0.93)
    • For development of preeclampsia <34 weeks: 73.3% (area under the curve 0.93)

CONCLUSION:

  • Decreased levels of PlGF in urine samples is associated with preeclampsia and related adverse outcomes at <34 weeks of gestation

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Learn More – Primary Sources:

Urinary Placental Growth Factor for Prediction of Placental Adverse Outcomes in High-Risk Pregnancies

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Related ObG Topics:

ISUOG Recommendations for Preeclampsia Prevention: Combined Screening and the Role of Ultrasound
Can the PlGF/sVEGFR-1 Ratio be Used to Predict Fetal Death?
Does Placental Growth Factor Lead to a Quicker Diagnosis in Women with Suspected Pre-Eclampsia?
FIGO First Trimester Preeclampsia Screening Guidelines: Prevention Using Clinical Information and Biomarkers
Results from the SPREE Trial: How Does First Trimester Preeclampsia Screening Compare to Current Guidelines?
The FMF Model: Maternal Characteristics, Ultrasound and PlGF to Predict Preterm Preeclampsia
Which Markers Can We Use to Screen for Early and Late Preeclampsia?

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