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. 2021 Aug:25:12-17.
doi: 10.1016/j.preghy.2021.05.011. Epub 2021 May 14.

Angiogenic factors and prediction for ischemic placental disease in future pregnancies

Katherine M Johnson  1 , Laura Smith  2 , Anna M Modest  2 , Saira Salahuddin  3 , S A Karumanchi  4 , Sarosh Rana  5 , Brett C Young  2
Affiliations

Angiogenic factors and prediction for ischemic placental disease in future pregnancies

Katherine M Johnson et al. Pregnancy Hypertens. 2021 Aug.

Abstract

Objectives: Ischemic placental disease (IPD), including preeclampsia, abruption, and fetal growth restriction, often recurs in subsequent pregnancies. Angiogenic factors of placental origin have been implicated in the pathogenesis of preeclampsia, but have not been studied as predictors of IPD in subsequent pregnancies. We hypothesized that elevated angiogenic factors in an index pregnancy would be associated with recurrence of IPD.

Study design: We conducted a retrospective cohort study of patients undergoing evaluation for preeclampsia who had angiogenic factors measured in an index pregnancy and experienced a subsequent pregnancy at the same institution. Patients with IPD in the index pregnancy were included. A high ratio of soluble fms-like tyrosine kinase 1 (sFlt1) and placental growth factor (PlGF) was defined as greater than or equal to 85.

Main outcome measures: The primary outcome was IPD in a subsequent pregnancy.

Results: We included 109 patients in the analysis. The sFlt1/PlGF ratio was elevated in 30% of participants. Those with an elevated ratio were more likely to be nulliparous in the index pregnancy, and less likely to have chronic hypertension. The recurrence of IPD in the study was 27%, with a non-significant difference in risk based on a high sFlt-1/P1GF ratio RR 0.58 (95% CI 0.21 - 1.6) compared to a low ratio.

Conclusions: A high sFlt1/P1GF ratio in an index pregnancy is not associated with a higher risk of IPD in a subsequent pregnancy. These data suggest placental angiogenic biomarkers are specific to the pregnancy and not a reflection of maternal predisposition to IPD.

Keywords: Abruption; Angiogenic factors; Ischemic placental disease; Preeclampsia; Small for gestational age.

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Conflict of interest statement

Declarations of interest: Dr. Rana reports serving as a consultant for Roche Diagnostics and Thermofisher and has received research funding from Roche and Siemens. Dr. Karumanchi is co-listed as co-inventors on patents related to preeclampsia biomarkers that are held at Beth Israel Deaconess Medical Center. He has financial interest in Aggamin LLC and also reports serving as a consultant to Roche Diagnostics and Thermofisher. Dr. Karumanchi has received research funding from Siemens and Thermofisher. Other authors report no conflicts.

Figures

Figure 1:
Figure 1:
Incidence of IPD and its components in a subsequent pregnancy, stratified by index pregnancy type of ischemic placental disease, as well as high and low angiogenic factor ratio.
See this image and copyright information in PMC

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