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CME Credit Offered
CME Credit Offered
Abstract Award
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Poster Session 3

(886) The predictive value of angiogenic factors in suspected preeclampsia

Friday, January 31, 2025
10:30 AM – 12:30 PM  
Objective: To evaluate the ability of circulating maternal levels of angiogenic factors – soluble FMS-like tyrosine kinase 1 (sFlt-1) and placental growth factor (PlGF) – to predict the development of preeclampsia with severe features (SPE).

Study Design: This was a single-center prospective observational study of pregnant patients admitted for evaluation of hypertensive disorders of pregnancy (HDP) between 24 0/7 weeks and 36 6/7 weeks. At enrollment, a single plasma sample was obtained for the measurement of sFlt-1 and PlGF. All patients underwent standardized evaluation for HDP and were diagnosed with SPE based on standard laboratory and clinical criteria. Patients were examined in two cohorts: those who developed SPE within 1 week (Cohort 1) and those who did not (SPE > 1 week or never, Cohort 2). The predictive value of sFlt-1, PlGF and sFlt-1:PlGF ratio for the development of SPE was analyzed using logistic regression. Demographic, maternal, and neonatal outcomes were compared between cohorts.

Results: From Nov 2022 to May 2023, 152 patients were enrolled, including 60 (39%) diagnosed with SPE, 14 (9%) within 1 week of enrollment (Cohort 1). There were no demographic differences between groups. Patients in Cohort 1 had higher levels of sFlt-1 (43.4 vs 20.3 ng/mL, p-value < 0.001), lower levels of PlGF (150.9 vs 319.0 pg/mL, p-value < 0.001), and higher sFlt-1:PlGF (460 vs 79, p-value < 0.001) versus patients in Cohort 2 (Figure 1). Levels of sFlt-1 and sFlt-1:PlGF were predictive of the development of SPE within 1 week (AUC 0.85 (95%CI 0.74, 0.95) and 0.82 (95%CI 0.71, 0.93), respectively) (Figure 2). At a cutoff of 28 ng/mL, sFlt-1 was associated with a negative predictive value of 0.97, effectively ruling out SPE in these patients. 

Conclusion: In pregnant patients with elevated blood pressure between 24 and 36 weeks gestation, elevated sFlt-1 and low PlGF levels are associated with the development of SPE. Levels of sFlt-1 below 28 ng/mL may serve as a triage tool to rule out SPE within 1 week.