Abstract
Objectives
Hypertensive disorders of pregnancy (HDP) remain significant contributors to maternal
and neonatal morbidity and mortality. These conditions arise from an imbalance between
pro- and antiangiogenic factors from the placenta. The soluble fms-like tyrosine kinase-1/placental
growth factor (sFlt-1/PlGF) ratio has emerged as a promising biomarker for predicting
preeclampsia and its complications. This study evaluates the clinical utility of the
sFlt-1/PlGF ratio in predicting adverse outcomes and guiding management.
Methods
In this observational cohort study, pregnant women, either diagnosed with or at high
risk for HDP, were recruited. Serum levels of sFlt-1 and PlGF were measured, and patients
were classified into two groups based on a cutoff ratio of 38. Strict fetomaternal
surveillance was done until delivery. Statistical analyses included comparisons of
outcomes between groups and the predictive performance of the sFlt-1/PlGF ratio using
receiver operating characteristic (ROC) curves.
Results
The study found that a high sFlt-1/PlGF ratio (> 38) was significantly associated
with an increased likelihood of adverse fetomaternal outcomes. The high ratio group
had a higher incidence of preeclampsia (75% vs. 20%, p = 0.0012), fetal growth restriction (65% vs. 5%, p = 0.0001), and a shorter enrolment and delivery period (median 13.5 vs. 23 days,
p = 0.04884). ROC analysis demonstrated strong predictive performance with an area
under the curve of 0.892, indicating high accuracy in identifying patients at risk
for adverse outcomes.
Conclusion
The sFlt-1/PlGF ratio effectively stratified patients into high risk and low risk
categories for adverse fetomaternal outcomes. This study supports the integration
of the sFlt-1/PlGF ratio into clinical practice to enhance risk assessment and decision
making in managing HDP.
Implications in Clinical Practice
This study highlights the clinical utility of the sFlt-1/PlGF ratio in the management
of HDP. By effectively stratifying patients into high risk and low risk categories,
this biomarker enables targeted surveillance and intervention, reducing unnecessary
hospital admissions and improving maternal and fetal outcomes. Its integration into
routine prenatal care can enhance risk assessment and optimize resource allocation,
particularly in low resource settings.
Keywords
preeclampsia - hypertensive disorders of pregnancy - sFlt-1/PlGF ratio - preterm delivery
- fetal growth restriction
