title: Clinical characterization and outcomes of preeclampsia with normal angiogenic profile.
abstract: OBJECTIVE
  To compare the clinical characteristics and outcomes of preeclamptic women presenting with a normal plasma angiogenic profile with those subjects who are characterized by an abnormal angiogenic profile.
  
  
  METHODS
  This was a secondary analysis of a prospective cohort study in women presenting to obstetrical triage at <37 weeks of gestation and diagnosed with preeclampsia within 2 weeks of enrollment and in whom angiogenic factors (sFlt1 and PlGF) measurements were available. Patients were divided into two groups based on their circulating levels of these factors described as a ratio; the sFlt1/PlGF ratio, non-angiogenic preeclampsia (sFlt1/PlGF ratio <85) and angiogenic preeclampsia (sFlt1/PlGF ratio ≥85). The data are presented by sFlt1/PlGF category using median and quartile 1-quartile 3 for continuous variables and by frequency and sample sizes for categorical variables.
  
  
  RESULTS
  In our cohort, the patients with non-angiogenic preeclampsia (N = 46) were more obese [BMI: 35.2 (31.6, 38.7) versus 31.1 (28.0, 39.0), p = 0.04], more likely to have preexisting diabetes (21.7% versus 2.0%, p = 0.002) and presented at a later gestational age [35 (32, 37) versus 32 (29, 34) weeks, p < 0.0001] as compared with women with angiogenic preeclampsia (N = 51). Women with non-angiogenic preeclampsia had no serious adverse outcomes (elevated liver function tests/low platelets: 0% versus 23.5%, abruption: 0% versus 9.8%, pulmonary edema: 0% versus 3.9%, eclampsia: 0% versus 2.0 %, small for gestational age: 0% versus 17.7% and fetal/neonatal death: 0% versus 5.9%) as compared with women with angiogenic preeclampsia. The rate of preterm delivery <34 weeks was 8.7% in non-angiogenic preeclampsia compared with 64.7% in angiogenic preeclampsia (p < 0.0001). Interestingly, delivery between 34 and 37 weeks and resource utilization (hospital admission days) were similar in the two groups.
  
  
  CONCLUSIONS
  In contrast to the angiogenic form, the non-angiogenic form of preeclampsia is characterized by little to no risk of preeclampsia-related adverse outcomes, other than iatrogenic prematurity. Incorporation of angiogenic biomarkers in the evaluation of preeclampsia may allow accurate and early identification of severe disease.
authors.affiliation: Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA. srana1@bidmc.harvard.edu
authors.forename: Sarosh
authors.initials: S
authors.lastname: Rana
authors.forename: William T
authors.initials: WT
authors.lastname: Schnettler
authors.forename: Camille
authors.initials: C
authors.lastname: Powe
authors.forename: Julia
authors.initials: J
authors.lastname: Wenger
authors.forename: Saira
authors.initials: S
authors.lastname: Salahuddin
authors.forename: Ana Sofia
authors.initials: AS
authors.lastname: Cerdeira
authors.forename: Stefan
authors.initials: S
authors.lastname: Verlohren
authors.forename: Frank H
authors.initials: FH
authors.lastname: Perschel
authors.forename: Zoltan
authors.initials: Z
authors.lastname: Arany
authors.forename: Kee-Hak
authors.initials: KH
authors.lastname: Lim
authors.forename: Ravi
authors.initials: R
authors.lastname: Thadhani
authors.forename: S Ananth
authors.initials: SA
authors.lastname: Karumanchi
mesh_terms: D000328:Adult; D001900:Boston / Q000453:epidemiology; D005260:Female; D006801:Humans; D009389:Neovascularization, Pathologic; D000072483:Placenta Growth Factor; D011225:Pre-Eclampsia / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D011247:Pregnancy; D011257:Pregnancy Proteins / Q000097:blood*; D047928:Premature Birth / Q000453:epidemiology; D011446:Prospective Studies; D040281:Vascular Endothelial Growth Factor Receptor-1 / Q000097:blood*
chemical_list: C000608036:PGF protein, human; D011257:Pregnancy Proteins; D000072483:Placenta Growth Factor; C501162:FLT1 protein, human; D040281:Vascular Endothelial Growth Factor Receptor-1