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21: Circulating concentrations of angiogenic factors to predict early delivery in preeclampsia before 34 weeks

      Objective

      To determine whether after onset of preeclampsia (PE) before 34 wks serum concentrations of soluble fms-like tyrosine kinase 1 (sFlt1), soluble endoglin (sEng), and placental growth factor (PlGF) can predict early delivery.

      Study design

      Angiogenic factors were measured in 5501 samples obtained from 2200 nulliparas before onset of gestational hypertension or PE. Samples at each GA wk were augmented with samples from the preceding and following wk to determine the concentration range in normotensive women for that GA wk. Concentrations in samples obtained after onset of disease from 107 women with PE were compared to the normotensive GA wk-specific distributions. PE onset was the time of the first measurement leading to diagnosis.

      Results

      Of 107 women with PE, 16 developed PE before 34 wks. Among them, sFlt1 exceeded the 99th percentile of the normotensive range in 10 of 10 delivered before 34 wks vs 0 of 6 delivered beyond 34 wks (P<0.001). Corresponding numbers for sEng were 8 of 10 vs 2 of 6 (P=0.12); and for PlGF below the 1st percentile, 7 of 10 vs 2 of 6 (P=0.30). The interval between PE onset and delivery for women delivered before 34 wks was 2.4 - 27.3 days.

      Conclusion

      Serum sFlt1 may be useful for managing women with PE onset before 34 wks. If these findings are confirmed, women with levels above the 99th percentile of the normotensive range should be considered for administration of steroids and delivery.
      Figure thumbnail gr1
      Serum sFlt1 by GA Week of Collection in Normotensive Women (box 25-75 percentiles, whiskers 5-95 percentiles) and Women with PE <34 Wks [delivery <34 Wks (filled squares); >=34 Wks (filled circles)]