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Angiogenic factors and the risk of adverse outcomes in women with suspected preeclampsia.

ABSTRACT: An imbalance in circulating angiogenic factors plays a central role in the pathogenesis of preeclampsia.We prospectively studied 616 women who were evaluated for suspected preeclampsia. We measured plasma levels of antiangiogenic soluble fms-like tyrosine kinase 1 (sFlt1) and proangiogenic placental growth factor (PlGF) at presentation and examined for an association between the sFlt1/PlGF ratio and subsequent adverse maternal and perinatal outcomes within 2 weeks. The median sFlt1/PlGF ratio at presentation was elevated in participants who experienced any adverse outcome compared with those who did not (47.0 [25th-75th percentile, 15.5-112.2] versus 10.8 [25th-75th percentile, 4.1-28.6]; P<0.0001). Among those presenting at <34 weeks (n=167), the results were more striking (226.6 [25th-75th percentile, 50.4-547.3] versus 4.5 [25th-75th percentile, 2.0-13.5]; P<0.0001), and the risk was markedly elevated when the highest sFlt1/PlGF ratio tertile was compared with the lowest (odds ratio, 47.8; 95% confidence interval, 14.6-156.6). Among participants presenting at <34 weeks, the addition of sFlt1/PlGF ratio to hypertension and proteinuria significantly improved the prediction for subsequent adverse outcomes (area under the curve, 0.93 for hypertension, proteinuria, and sFlt1/PlGF versus 0.84 for hypertension and proteinuria alone; P=0.001). Delivery occurred within 2 weeks of presentation in 86.0% of women with an sFlt1/PlGF ratio ?85 compared with 15.8% of women with an sFlt1/PlGF ratio <85 (hazard ratio, 15.2; 95% confidence interval, 8.0-28.7).In women with suspected preeclampsia presenting at <34 weeks, circulating sFlt1/PlGF ratio predicts adverse outcomes occurring within 2 weeks. The accuracy of this test is substantially better than that of current approaches and may be useful in risk stratification and management. Additional studies are warranted to validate these findings.

SUBMITTER: Rana S

PROVIDER: S-EPMC3319742 | biostudies-literature | 2012 Feb

REPOSITORIES: biostudies-literature

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Angiogenic factors and the risk of adverse outcomes in women with suspected preeclampsia.

Rana Sarosh S Powe Camille E CE Salahuddin Saira S Verlohren Stefan S Perschel Frank H FH Levine Richard J RJ Lim Kee-Hak KH Wenger Julia B JB Thadhani Ravi R Karumanchi S Ananth SA

Circulation 20120118 7

<h4>Background</h4>An imbalance in circulating angiogenic factors plays a central role in the pathogenesis of preeclampsia.<h4>Methods and results</h4>We prospectively studied 616 women who were evaluated for suspected preeclampsia. We measured plasma levels of antiangiogenic soluble fms-like tyrosine kinase 1 (sFlt1) and proangiogenic placental growth factor (PlGF) at presentation and examined for an association between the sFlt1/PlGF ratio and subsequent adverse maternal and perinatal outcomes ...[more]

PMID: 22261192

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Project description:BackgroundPre-eclampsia (PE) is one of the leading causes of maternal morbidity and mortality globally. Adequate knowledge about a disorder contributes greatly to its prevention, control and management. This study assessed the level of knowledge of PE and evaluated the factors associated with knowledge adequacy among pregnant women attending antenatal care at a University Hospital in Kumasi-Ghana.MethodsThis cross-sectional study was conducted at the University Hospital in Kumasi, Ghana. A validated closed-ended questionnaire was used to collect socio-demographic information and history of PE. Knowledge of PE was assessed based on a series of questions regarding the awareness, signs/symptoms, risk factors and complications of PE. Responses were scored percentage-wise and grouped into low (< 60%), moderate (60-80%) and high (80-100%). Knowledge score was then re-stratified into adequate (% score of ≥60%) and inadequate knowledge of PE (% score of < 60%).ResultsThe prevalence of inadequate and adequate knowledge of PE was 88.6% (mean score = 55.5 ± 4.3%) and 11.4% (mean score = 76.3 ± 5.9%), respectively. For participants with adequate knowledge of PE, 9.1% (mean score = 67.4 ± 6.9%) and 2.3% (mean score = 85.2 ± 5.1%) had moderate and high knowledge, respectively. Using univariate logistic regression models, being older (> 35 years old) [cOR = 3.09, 95%CI (0.88-10.88), p = 0.049] and having a higher level of education (> SHS education) [cOR = 4.45, 95%CI (2.18-9.10), p < 0.0001] were significantly associated with greater odds of having adequate knowledge of PE. After controlling for potential confounders in multivariate logistic regression analysis, we found higher level of education to be independently associated with adequate knowledge of PE [aOR = 2.87, 95%CI (1.31-6.30), p = 0.008].ConclusionThe knowledge of PE among pregnant women in Ghana is low. The prominent factor that facilitates adequacy of knowledge of PE is higher level of education.

Project description:BackgroundThis study was conducted to evaluate how the preeclampsia integrated estimate of risk (fullPIERS) model performs in the prediction of adverse maternal outcomes when the predictor variables are all obtained within 24-h of admission for preeclampsia.MethodsA prospective cohort study on 323 women who fulfilled definite inclusion and exclusion criteria was conducted. Subjects were monitored for clinical symptoms of preeclampsia, biochemical parameters, and adverse maternal and neonatal outcomes. A risk prediction score was calculated using the fullPIERS calculator. Statistical analysis of rates and ratios was carried out by assessing ? (2) test and odds ratio.Results18.3 % (n = 60) had adverse maternal outcome and 42.8 % (n = 138) had adverse fetal outcome, and 43 (13.35 %) had combined adverse maternal and perinatal outcome. Dyspnea, visual disturbances, epigastric pain, and [Formula: see text] appeared to be highly significant risk factors. In the biochemical variables studied, serum creatinine and serum uric acid were found to have a significant association. The association between adverse perinatal outcome and vaginal delivery was highly significant (OR 0.35, 95 % CI 0.19, 0.63), and the P value was 0.0005. The likelihood ratio associated with the highest risk group (predicted probability of the outcome ?30 %) showed excellent performance (i.e., 17.5) of fullPIERS model as a rule in test.ConclusionThe fullPIERS model performed well in the prediction of adverse maternal outcomes in women with preeclampsia. It is easy to use. The model is based on the use of few important clinical and biochemical parameters and does not require extensive laboratory testing. Although it might be of limited use in a well-equipped tertiary care facility, this model can be utilized in the setting of district or sub-district level hospitals to identify patients who are at risk of complications due to preeclampsia. Timely referral to a higher center will help in reducing the morbidity and mortality associated with this condition.

Project description:To compare the clinical characteristics and outcomes of preeclamptic women presenting with a normal plasma angiogenic profile with those subjects who are characterized by an abnormal angiogenic profile.This was a secondary analysis of a prospective cohort study in women presenting to obstetrical triage at <37 weeks of gestation and diagnosed with preeclampsia within 2 weeks of enrollment and in whom angiogenic factors (sFlt1 and PlGF) measurements were available. Patients were divided into two groups based on their circulating levels of these factors described as a ratio; the sFlt1/PlGF ratio, non-angiogenic preeclampsia (sFlt1/PlGF ratio <85) and angiogenic preeclampsia (sFlt1/PlGF ratio ?85). The data are presented by sFlt1/PlGF category using median and quartile 1-quartile 3 for continuous variables and by frequency and sample sizes for categorical variables.In our cohort, the patients with non-angiogenic preeclampsia (N?=?46) were more obese [BMI: 35.2 (31.6, 38.7) versus 31.1 (28.0, 39.0), p?=?0.04], more likely to have preexisting diabetes (21.7% versus 2.0%, p?=?0.002) and presented at a later gestational age [35 (32, 37) versus 32 (29, 34) weeks, p?<?0.0001] as compared with women with angiogenic preeclampsia (N?=?51). Women with non-angiogenic preeclampsia had no serious adverse outcomes (elevated liver function tests/low platelets: 0% versus 23.5%, abruption: 0% versus 9.8%, pulmonary edema: 0% versus 3.9%, eclampsia: 0% versus 2.0 %, small for gestational age: 0% versus 17.7% and fetal/neonatal death: 0% versus 5.9%) as compared with women with angiogenic preeclampsia. The rate of preterm delivery <34 weeks was 8.7% in non-angiogenic preeclampsia compared with 64.7% in angiogenic preeclampsia (p?<?0.0001). Interestingly, delivery between 34 and 37 weeks and resource utilization (hospital admission days) were similar in the two groups.In contrast to the angiogenic form, the non-angiogenic form of preeclampsia is characterized by little to no risk of preeclampsia-related adverse outcomes, other than iatrogenic prematurity. Incorporation of angiogenic biomarkers in the evaluation of preeclampsia may allow accurate and early identification of severe disease.

Project description:IntroductionAdverse birth outcomes particularly preterm births and congenital anomalies, are the leading causes of infant mortality globally, and the burden is highest in developing countries. We set out to determine the frequency of adverse birth outcomes and the risk factors associated with such outcomes in a cohort of pregnant women in Kenya.MethodsFrom October 2017 to July 2019, pregnant women < 28 weeks gestation were enrolled and followed up until delivery in three hospitals in coastal Kenya. Newborns were examined at delivery. Among women with birth outcome data, we assessed the frequency of congenital anomalies defined as gastroschisis, umbilical hernia, limb abnormalities and Trisomy 21, and adverse birth outcomes, defined as either stillbirth, miscarriage, preterm birth, small for gestational age, or microcephaly. We used log-binomial regression to identify maternal characteristics associated with the presence of at least one adverse outcome.ResultsAmong the 2312 women enrolled, 1916 (82.9%) had birth outcome data. Overall, 402/1916 (20.9%; 95% confidence interval (CI): 19.1-22.8) pregnancies had adverse birth outcomes. Specifically, 66/1916 (3.4%; 95% CI: 2.7-4.4) were stillbirths, 34/1916 (1.8%; 95% CI: 1.2-2.4) were miscarriages and 23/1816 (1.2%; 95% CI: 0.8-1.9) had congenital anomalies. Among the participants with anthropometric measurements data, 142/1200 (11.8%; 95% CI: 10.1 - 13.8) were small for gestational age and among the participants with ultrasound records, 143/1711 (8.4%; 95% CI: 7.1-9.8) were preterm. Febrile illnesses in current pregnancy (adjusted risk ratio (aRR): 1.7; 95% CI: 1.1-2.8), a history of poor birth outcomes in prior pregnancy (aRR: 1.8; 95% CI: 1.3-2.4) and high blood pressure in pregnancy (aRR: 3.9, 95% CI: (1.7-9.2) were independently associated with adverse birth outcomes in a model that included age, education, human immunodeficiency virus status and high blood pressure at enrolment.ConclusionWe found similar rates of overall adverse birth outcomes, congenital anomalies, and small for gestational age but higher rates of stillbirths and lower rates of prematurity compared to the rates that have been reported in the sub-Saharan Africa region. However, the rates of adverse birth outcomes in this study were comparable to other studies conducted in Kenya. Febrile illnesses during the current pregnancy, previous history of poor birth outcomes and high blood pressure in pregnancy are predictive of an increased risk of adverse birth outcomes.

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Angiogenic factors and the risk of adverse outcomes in women with suspected preeclampsia.

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Angiogenic factors and the risk of adverse outcomes in women with suspected preeclampsia.

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