Repeated controls of gestational angiogenic biomarkers in high-risk pregnancies – do they derive a clinical benefit?

Problem Statement:

Pathogenesis of severe placenta mediated gestational complications (preeclampsia, eclampsia, HELLP-Syndrome, abruption of placenta, IUGR) are associated with altered angiogenic biomarker levels. Aim of this study is to determine if maternal serum angiogenic biomarker ratio (sFlt1/PIGF) can predict maternal and/or fetal, neonatal complications during pregnancy.

Methods:

We prospectively studied 94 women with high-risk pregnancies (previous preeclampsia/eclampsia/HELLPSyndrom, preexisting hypertension, thrombophilia, antiphospholipid-syndrom). We measured serum levels of sFlt-1 and PLGF by ELISA and calculated sFlt-1/PLGF-ratio every 4 – 6 weeks from week 10 until the end of pregnancy. Maternal and fetal/neonatal complications were analyzed subsequently. We also evaluated effects of applied medication (acetylsalicylic acid, low molecular heparin) on gestational biomarker levels.

Results:

sFlt-1/PLGF ratio was higher in women with adverse pregnancy outcome, even without preeclampsia, i.e. early placenta abruption at 24th week of pregnancy. Application of acetylsalicylic acid and/or heparin was associated with an immediate and constant strong decrease of the ratio after administration.

Conclusion:

Women with high risk to develop severe complications during pregnancy like abruption of placenta or severe preeclampsia showed strong increase of sFlt-1/PIGF ratio up to twelve weeks before clinical manifestation of these events. Protective effects of acetylsalicylic acid can be demonstrated once again by a decrease of sFlt-1/PLGF ratio levels in our study.

Further Results of this ongoing study are going to be presented at the Gestosis Meeting in Seggau, Austria, in April 2015.