Examination of SFLT1/PLGF ratio in the second and third trimesters of pregnancy in predicting preeclampsia

Abstract

Background: Pre-eclampsia (PE) is a critical pregnancy complication leading to adverse perinatal outcomes like fetal growth restriction, stillbirth, oligohydramnios, eclampsia, and HELLP syndrome. An imbalance between pro-angiogenic (PlGF) and anti-angiogenic (sFLT-1) factors increases the sFLT-1/PlGF (sFlt1/PlGF) ratio, detectable about four weeks before the symptoms appear. The study was conducted to determine the predictive value of the sFlt1/PlGF ratio for the development of PE in high-risk pregnant women during the late 2^nd and 3^rd trimesters.

Methods: A Prospective, Monocentric, Observational study was conducted involving 50 high-risk pregnant females between 24 and 32 weeks of gestation. Participants were selected based on criteria such as age > 30 years, BMI > 30 kg/m², previous history of PE, PAPPA < 0.4 MoM, increased UtA PI at 11-13 weeks, twin pregnancy, IVF conception, and history of FGR. The sFlt1/PlGF ratio was determined, and participants were monitored for development of Pre Eclampsia . The study determined the specificity, sensitivity, positive predictive value (PPV), and negative predictive value (NPV) of sFlt1/PlGF ratio for the development of Pre eclampsia.

Results: The sFlt1/PlGF ratio demonstrated a high NPV of 96.7%, indicating a reliable prediction for the absence of PE within a week. The PPV was 63.5%, suggesting a strong indication of PE development with a high ratio (>38). The sensitivity of the ratio was 92.3%, and the specificity was 81.08%, confirming its effectiveness in correctly identifying both the presence and absence of pre-eclampsia.

Conclusion: The sFlt1/PlGF ratio is a valuable predictive tool for identifying the possibility of development of PE in high-risk pregnancies, with high NPV, sensitivity, and specificity. It effectively aids in early identification and management, potentially improving maternal and fetal outcomes.

Recommendations: Clinicians should consider incorporating the sFlt1/PlGF ratio in the routine assessment of high-risk pregnant women to enhance early detection and intervention strategies for pre-eclampsia.