25: First-trimester serum angiogenic factors and the risk of intrauterine fetal demise

Article Outline

• Objective
• Study design
• Results
• Conclusion
• Copyright

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Objective 

The purpose of this study was to determine whether increased maternal serum levels of soluble fms-like tyrosine kinase -1 (sFlt-1) and decreased levels of placental growth factor (PlGF) measured during the first trimester are associated with a subsequent increased risk of intrauterine fetal demise (IUFD).

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Study design 

We performed a prospective, nested case-control study of the Massachusetts General Hospital Obstetric Maternal Study (MOMS). This cohort included 34 cases of IUFD, as well as 246 randomly selected control women who delivered a healthy baby at term. First-trimester serum samples were assayed for circulating levels of sFlt-1 and PlGF by ELISA. We used logistic regression to assess the risk of IUFD according to baseline levels of angiogenic factors and to adjust for potential confounders.

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Results 

Women with IUFD had significantly increased first-trimester levels of sFlt-1 (1178 +/− 530 vs. 889 +/− 562 pg/ml; p<0.01) but there were no significant differences in PlGF levels according to pregnancy outcome (38.6 +/− 20.8 vs. 40.0 +/− 28.4 pg/ml; p=NS). In the unadjusted analysis, there was a 7% increase in risk of IUFD (RR 1.07; 95% CI 1.01- 1.14; p=0.02) with each 100 pg/ml increase in sFlt-1. There was no association between PlGF and IUFD. When sFlt-1 was analyzed according to tertiles based on women in the control group, the highest tertile (OR 9.59; 95% CI 1.92 - 48.0; p<0.01) was associated with a markedly increased risk of IUFD compared to the lowest tertile.

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Conclusion 

Increased maternal serum levels of sFlt-1 measured in the first trimester are independently associated with increased risk of IUFD.