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Open Access Research article

Vasoactive agents for the prediction of early- and late-onset preeclampsia in a high-risk cohort

Pia M Villa12*, Esa Hämäläinen3, Annukka Mäki3, Katri Räikkönen4, Anu-Katriina Pesonen4, Pekka Taipale56, Eero Kajantie78 and Hannele Laivuori129

Author Affiliations

1 The Research Programs Unit, Women’s Health, University of Helsinki, Helsinki, Finland

2 Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Central Hospital, Helsinki, PL140, 00029 HUS, Finland

3 HUSLAB and Department of Clinical Chemistry, Helsinki University Central Hospital, Helsinki, Finland

4 Faculty of Behavioural Sciences, Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland

5 Iisalmi Hospital, Iisalmi, Finland

6 Kuopio University Hospital, Kuopio, Finland

7 Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland

8 Hospital for Children and Adolescents, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland

9 Haartman Institute, Medical Genetics, University of Helsinki, Helsinki, Finland

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BMC Pregnancy and Childbirth 2013, 13:110  doi:10.1186/1471-2393-13-110

Published: 12 May 2013

Abstract

Background

To evaluate the soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF), and sFlt-1/PlGF ratio for the prediction of early- and late-onset preeclampsia in a high-risk cohort.

Methods

We studied serial serum samples collected prospectively at 12 + 0 - 14 + 0, 18 + 0 - 20 + 0, and 26 + 0 - 28 + 0 weeks + days of gestation in 6 women who developed early-onset preeclampsia (before 34 weeks of gestation) and in 21 women who developed late-onset preeclampsia (after 34 weeks of gestation) with automated ElecSys 2010 immunoanalyzer (Roche Diagnostics, Germany). Twenty-six high-risk women and 53 women without risk factors with normal pregnancies served as controls.

Results

Serum PlGF concentrations were lower at 18 + 0 to 20 + 0, and 26 + 0 to 28 + 0 weeks of gestation in women who developed early-onset preeclampsia compared to women who developed late-onset preeclampsia and to controls (p < 0.05 for all comparisons). At 18 + 0 to 20 + 0 weeks of gestation area under the receiver-operating characteristic curve (AUC) for serum PlGF was 99.8% (p = 0.0007, 95% CI 99.0-100.0). At 26 + 0 to 28 + 0 weeks of gestation serum sFlt-1/PlGF ratio explicitly detects those women who developed early-onset preeclampsia (AUC 100.0%, p = 0.0007, 95% CI 100–100). Amongst women with late-onset preeclampsia, those who developed severe form of the disease (N = 8) had significantly higher serum sFlt-1 concentrations at all three timepoints (p = 0.004, p = 0.006, and p = 0.003, respectively) compared to women with non-severe form (N = 13).

Conclusions

Low serum PlGF concentration predicts early-onset preeclampsia from the second trimester and elevated serum sFlt-1/PlGF ratio from 26 to 28 weeks of gestation. Elevated serum sFlt-1 concentration in the first trimester in women who later develop late-onset, severe preeclampsia may suggest different etiology compared to the late-onset non-severe form of the disease.

Keywords:
Preeclampsia; Prediction; Vasoactive agents; Placental growth factor; Soluble fms-like tyrosine kinase-1