Low placental growth factor across pregnancy identifies a subset of women with preterm preeclampsia: type 1 versus type 2 preeclampsia?
Preeclampsia is a heterogeneous syndrome affecting 3% to 5% of all pregnancies. An imbalance of the antiangiogenic and proangiogenic factors, soluble receptor fms-like tyrosine kinase 1 and placental growth factor (PGF), is thought to contribute to the pathophysiology of preeclampsia. Maternal plasma PGF and soluble receptor fms-like tyrosine kinase 1 were quantified by specific immunoassays in cross-sectional samples from 130 preeclamptic subjects and 342 normotensive controls at delivery and longitudinally in samples from 50 women who developed preeclampsia and 250 normotensive controls. Among women who developed preeclampsia, 46% (n=23) evidenced a pattern of consistently low maternal PGF across pregnancy below the lower 95% CI of controls from 15 weeks' gestation to term. In contrast, the remaining 54% (n=27) of women who developed preeclampsia had maternal PGF concentrations similar to or above (n=7) those of normotensive controls. Subjects with low PGF across pregnancy who developed preeclampsia evidenced significantly higher blood pressure in early pregnancy (P<0.05) and, after diagnosis, earlier gestational age at delivery (P<0.05) and more preterm birth (P<0.05) compared with preeclamptic patients with high PGF. A significant subset of women who develop preeclampsia show evidence of consistently low PGF across pregnancy. Low PGF with preeclampsia was associated with preterm delivery compared with preeclamptic patients with high PGF. Identifying women with consistently low plasma PGF during pregnancy may provide a greater understanding of preeclampsia pathophysiology and may provide more focused research and clinical activities.
Department of Obstetrics, Gynecology, and Reproductive SciencesMagee-Womens Research Institute, University of Pittsburgh, Pittsburgh, PA, USA. powersrw@upmc.edu
Robert W
RW
Powers
James M
JM
Roberts
Daniel A
DA
Plymire
Dominick
D
Pucci
Saul A
SA
Datwyler
Don M
DM
Laird
David C
DC
Sogin
Arun
A
Jeyabalan
Carl A
CA
Hubel
Robin E
RE
Gandley
D000293:Adolescent; D000328:Adult; D001794:Blood Pressure; D016022:Case-Control Studies; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D010920:Placenta / Q000378:metabolism*; D000072483:Placenta Growth Factor; D011225:Pre-Eclampsia / Q000097:blood* / Q000175:diagnosis / Q000378:metabolism; D011247:Pregnancy; D011257:Pregnancy Proteins / Q000097:blood* / Q000378:metabolism; D012189:Retrospective Studies; D013997:Time Factors; D040281:Vascular Endothelial Growth Factor Receptor-1 / Q000097:blood / Q000378:metabolism; D055815:Young Adult
C000608036:PGF protein, human; C000608037:Pgf protein, mouse; D011257:Pregnancy Proteins; D000072483:Placenta Growth Factor; C501163:Flt1 protein, mouse; D040281:Vascular Endothelial Growth Factor Receptor-1