Poster Presentation Society of Obstetric Medicine of Australia and New Zealand and Australasian Diabetes in Pregnancy Society Joint Scientific Meeting 2017

Mid-pregnancy Prediction of Preeclampsia using Placental Biomarkers (#125)

Carin Black 1 2 , Daniel Rolnik 3 4 , Ahmed Al-Amin 5 6 , Stefan Kane 1 2 , Adrienne White 1 , Caroline Stolarek 1 , Fabricio Costa 3 4 6 , Shaun Brennecke 1 2
  1. Department of Maternal-Fetal Medicine, The Royal Women's Hospital, Parkville, VIC, Australia
  2. Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia
  3. Perinatal Services, Monash Medical Centre, Clayton, VIC, Australia
  4. Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
  5. Pauline Gandel Imaging Centre, The Royal Women's Hospital, Parkville, VIC, Australia
  6. Monash Ultrasound for Women, Clayton, VIC, Australia

AIM Placental biomarkers soluble Fms-like tyrosine kinase-1 (sFLt1) and placental growth factor (PlGF), when tested at mid-pregnancy, may predict preeclampsia. We aimed to determine whether PlGF and/or the sFLt1/PlGF ratio can predict preeclampsia when tested at mid-pregnancy in our patient population, and which of these biomarkers displays the greatest clinical utility in this setting.

METHODS This prospective study in singleton pregnancies included women attending their first antenatal visit at 19-22 weeks gestation. Maternal characteristics and medical history were recorded. Maternal blood was tested for sFlt-1, PlGF and the sFlt-1/PlGF ratio using the cobas®e 411 analyser (Roche Diagnostics, GmbH). Preeclampsia was the outcome measured. Biomarker results were converted to multiples of the median (MoM). Mean values were compared between patients with preeclampsia and unaffected pregnancies, and screening performance of sFlt-1, PlGF and the sFlt-1/PlGF ratio evaluated using receiver operating characteristic (ROC) curves.

RESULTS 512 patients were included. PlGF MoM values were significantly reduced in patients with preterm (<37 weeks) preeclampsia (p<0.05). Sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) for prediction of preterm preeclampsia were 62.5%, 84.6%, 99.3% and 6.3%, respectively, with AUC 0.783. sFlt1 and sFLt1/PlGF ratio values were not significantly different between patients with preterm preeclampsia and unaffected pregnancies, and sFlt1 did not further enhance prediction rates. Patients with term (≥37 weeks) preeclampsia displayed no significant difference in sFLt1, PlGF or the sFLt1/PlGF ratio compared with unaffected pregnancies.

CONCLUSION PlGF MoM values appear to effectively predict preterm preeclampsia at mid-pregnancy in asymptomatic women. PPV, and hence clinical utility, could be improved by reserving screening for high risk populations, or identifying high risk individuals based on clinical factors prior to screening. The addition of our PlGF values to a multivariate prediction model may further enhance the clinical utility of screening for preterm preeclampsia in our patient population.