BACKGROUND
Novel angiogenic biomarker profiles have demonstrated emerging evidence for predicting
preeclampsia onset, severity, and adverse outcomes. Limited data exist in screening
patients with fetal growth restriction for preeclampsia development using angiogenic
biomarkers.
OBJECTIVE
The objective of this study was to risk stratify patients with fetal growth restriction
using a soluble fms-like tyrosine kinase-1 to placental growth factor ratio. Previously
published cutoff of 38 was used to predict preeclampsia development and severity as
well as adverse maternal or neonatal outcomes within a 2-week time period.
STUDY DESIGN
This was a prospective observational cohort study performed in a single tertiary hospital.
Patients with a singleton fetal growth restriction pregnancy between 24 and 37 weeks’
gestation were evaluated using serial 2-week encounters from the time of enrollment
to delivery. Pregnancies with proven genetic or infectious etiology of fetal growth
restriction or congenital anomalies were excluded. Ultrasound growth and Doppler measurements
were obtained at the start of every encounter with routine preeclampsia laboratory
tests and blood pressure checks when clinically indicated. Maternal serum was collected
for all serial encounters and measured for soluble fms-like tyrosine kinase-1 and
placental growth factor after delivery in a double-blinded fashion. Maternal charts
were reviewed for baseline demographic characteristics, pregnancy diagnoses and outcomes,
and neonatal outcomes.
RESULTS
A total of 45 patients were enrolled for a total of 77 encounters, with the median
(quartile 1, quartile 3) gestational age of the study enrolled at 31.43 (28.14–33.57)
weeks. Patients were divided into low-risk (ratio of <38) and high-risk (ratio of
≥38) groups. Baseline characteristics of patients did not show any marked differences,
including preeclampsia labs or ultrasound parameters, between the 2 groups. Systolic
and diastolic blood pressures upon enrollment were statistically elevated when soluble
fms-like tyrosine kinase-1 to placental growth factor ratio was ≥38 (P=.02 and P=.01, respectively). Compared to patients with a low ratio, patients with a high ratio
had a greater proportion of preeclampsia diagnosis, higher rates of preterm delivery
under 34 and 37 weeks gestation, smaller neonatal birthweight, and a shorter time
to delivery from testing to delivery.
CONCLUSION
Among patients with fetal growth restriction, the soluble fms-like tyrosine kinase-1
to placental growth factor ratio may serve as a potential biomarker for identifying
at risk patients for developing preeclampsia and subsequently preterm delivery.
Key words
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Article info
Publication history
Published online: May 12, 2021
Accepted:
May 3,
2021
Received in revised form:
April 26,
2021
Received:
February 17,
2021
Footnotes
S.R. reports serving as a consultant to Roche Diagnostics Corporation and Thermo Fisher Scientific and has funding from Roche Diagnostics Corporation and Siemens for studies related to the use of angiogenic factors in pregnancy. A.M. reports serving as a statistical consultant to Roche Diagnostics Corporation. J.S.A. is on the medical consultant board for Samsung Medical and an author for UpToDate. The remaining authors report no conflict of interest.
This project was funded through an investigator-initiated study funded by Roche Diagnostics Corporation given to S.R. Roche played no part in the study design, analysis, or article preparation.
Cite this article as: Arenas GA, Tang NY, Mueller A, et al. Use of the angiogenic biomarker profile to risk stratify patients with intrauterine growth restriction. Am J Obstet Gynecol MFM 2021;XX:x.ex–x.ex.
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