Identification of patients at risk for early onset and/or severe preeclampsia with the use of uterine artery Doppler velocimetry and placental growth factor

Objective Preeclampsia has been proposed to be an antiangiogenic state that may be detected by the determination of the concentrations of the soluble vascular endothelial growth factor receptor-1 (sVEGFR-1) and placental growth factor (PlGF) in maternal blood even before the clinical development of...

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Published in:	American journal of obstetrics and gynecology 2007-04, Vol.196 (4), p.326.e1-326.e13
Main Authors:	Espinoza, Jimmy, MD, Romero, Roberto, MD, Nien, Jyh Kae, MD, Gomez, Ricardo, MD, Kusanovic, Juan Pedro, MD, Gonçalves, Luis F., MD, Medina, Luis, MD, Edwin, Sam, PhD, Hassan, Sonia, MD, Carstens, Mario, MD, Gonzalez, Rogelio, MD
Format:	Article
Language:	eng
Subjects:	Adult Biomarkers - analysis Chi-Square Distribution Cohort Studies Female gestational hypertension Humans Obstetrics and Gynecology Placenta - metabolism Placenta Growth Factor placental growth factor (PlGF) Pre-Eclampsia - diagnosis Pre-Eclampsia - mortality Predictive Value of Tests preeclampsia Pregnancy Pregnancy Outcome Pregnancy Proteins - analysis Pregnancy Proteins - metabolism Pregnancy Trimester, Second Probability Prospective Studies Sensitivity and Specificity Severity of Illness Index small for gestational age soluble vascular endothelial growth factor receptor-1 (VEGFR-1) Survival Analysis Time Factors Ultrasonography, Doppler Ultrasonography, Prenatal uterine artery Doppler velocimetry Uterus - blood supply Uterus - diagnostic imaging vascular endothelial growth factor (VEGF) Vascular Endothelial Growth Factor Receptor-1 - analysis Vascular Endothelial Growth Factor Receptor-1 - metabolism
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Summary:	Objective Preeclampsia has been proposed to be an antiangiogenic state that may be detected by the determination of the concentrations of the soluble vascular endothelial growth factor receptor-1 (sVEGFR-1) and placental growth factor (PlGF) in maternal blood even before the clinical development of the disease. The purpose of this study was to determine the role of the combined use of uterine artery Doppler velocimetry (UADV) and maternal plasma PlGF and sVEGFR-1 concentrations in the second trimester for the identification of patients at risk for severe and/or early onset preeclampsia. Study Design A prospective cohort study was designed to examine the relationship between abnormal UADV and plasma concentrations of PlGF and sVEGFR-1 in 3348 pregnant women. Plasma samples were obtained between 22 and 26 weeks of gestation at the time of ultrasound examination. Abnormal UADV was defined as the presence of bilateral uterine artery notches and/or a mean pulsatility index above the 95th percentile for the gestational age. Maternal plasma PlGF and sVEGFR-1 concentrations were determined with the use of sensitive and specific immunoassays. The primary outcome was the development of early onset preeclampsia (≤34 weeks of gestation) and/or severe preeclampsia. Secondary outcomes included preeclampsia, the delivery of a small for gestational age (SGA) neonate without preeclampsia, spontaneous preterm birth at ≤32 and ≤35 weeks of gestation, and a composite of severe neonatal morbidity. Contingency tables, chi-square test, receiver operating characteristic curve, and multivariate logistic regression were used for statistical analyses. A probability value of
ISSN:	0002-9378 1097-6868