14: Circulating angiogenic factors in spontaneous preterm labor and delivery

Article Outline

• Objective
• Study design
• Results
• Conclusion
• Copyright

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Objective 

To determine whether spontaneous preterm (SPT) labor and delivery (L&D), like preeclampsia, is accompanied by elevated maternal serum concentrations of soluble fms-like tyrosine kinase 1 (sFlt1) and soluble endoglin (sEng) and reduced levels of free placental growth factor (PlGF).

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Study design 

2200 nulliparas were randomly selected from the CPEP trial. After excluding women with gestational hypertension or preeclampsia, 1609 remained of whom 125 delivered before 37 wks (preterm) after spontaneous labor and 1463 delivered at 37 wks or later (term) . Serum angiogenic factor concentrations were measured in all 4055 specimens obtained before delivery. Significance was acertained on log-transformed data after adjustment for GA and race.

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Results 

Compared with women delivered at term following spontaneous labor, women with SPT L&D had higher sEng at 21-32 wks (5.6 vs 5.3 ng/ml, P<0.01); higher sFlt1 (10948 vs 7248 pg/ml, P<0.01) and sEng (12.0 vs 9.8, P<0.01) at 33-36 wks; and lower PlGF at 33-36 wks (281 vs 613 pg/ml, P<0.001). In analyses by wks before SPT delivery, comparing angiogenic factors in specimens obtained from women with SPT L&D to GA-matched specimens from women with term delivery, sEng was elevated beginning 6-8 wks before SPT delivery (6.1 vs 5.2 ng/ml, P<0.01); sFlt1 was elevated (5333 vs 4457 pg/ml, P<0.05) 2-5 wks before and PlGF reduced (305 vs 680 pg/ml, P<0.01) the week before SPT delivery.

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Conclusion 

Modest increases in maternal serum sFlt1 and sEng and decreases in free PlGF are associated with spontaneous preterm labor and delivery.