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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