title: Placental lesions of vascular insufficiency are associated with anti-angiogenic state in women with preeclampsia.
abstract: OBJECTIVE
  To evaluate if placental histopathological changes of vascular insufficiency correlate with circulating angiogenic factors in patients with preeclampsia.
  
  
  METHODS
  Subjects were selected from a previous prospective cohort study of preeclampsia based on the availability of plasma anti-angiogenic factor (sFlt1) and pro-angiogenic factor (PlGF) measurements and placental histology specimens. Preeclamptic patients were divided into two groups based on plasma levels of these factors described as a ratio: anti-angiogenic preeclampsia with sFlt1/PlGF ratio ≥85 and normal angiogenic preeclampsia with sFlt1/PlGF < 85. The placental lesions of vascular insufficiency that were studied specifically included atherosis, infarcts, syncytial knots, acute and chronic abruption, hematoma, and fetal thrombosis. The data are shown as median (quartile 1 and quartile 3) or n (%) when appropriate.
  
  
  RESULTS
  The anti-angiogenic preeclampsia group (N = 48) presented at an earlier gestational age (weeks) than the normal angiogenic group (N = 28); {32 (28, 34) versus 35 (32, 36), p = 0.002}, had higher systolic blood pressure (mmHg) {154 (147, 168) versus 147 (132, 158), p = 0.02}, delivered early (weeks) {(32 (29, 34) versus 36 (34, 37), p < 0.001} and had lower birth weight (grams) {(1550 (1055, 2060) versus 2655 (2285, 3343), p < 0.001}. Several pathologic lesions were found significantly more often in the anti-angiogenic preeclampsia group; atherosis {27.7% versus 3.6%, p < 0.05}, infarcts {58.3% versus 3.6%, p = 0.002}, and syncytial knots {81.3% versus 39.3%, p < 0.001}.
  
  
  CONCLUSIONS
  Preeclamptic patients with imbalance in circulating angiogenic factors have disproportionally higher rates of placental vascular lesions historically associated with severe disease.
authors: Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology .
authors: Kedak
authors: K
authors: Baltajian
authors: Jonathan L
authors: JL
authors: Hecht
authors: Julia B
authors: JB
authors: Wenger
authors: Saira
authors: S
authors: Salahuddin
authors: Stefan
authors: S
authors: Verlohren
authors: Frank H
authors: FH
authors: Perschel
authors: Zsuzsanna K
authors: ZK
authors: Zsengeller
authors: Ravi
authors: R
authors: Thadhani
authors: S Ananth
authors: SA
authors: Karumanchi
authors: Sarosh
authors: S
authors: Rana
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D010920:Placenta / Q000473:pathology*; D000072483:Placenta Growth Factor; D010927:Placental Insufficiency / Q000097:blood / Q000473:pathology*; D011225:Pre-Eclampsia / Q000097:blood / Q000473:pathology*; D011247:Pregnancy; D011257:Pregnancy Proteins / Q000097:blood*; D040281:Vascular Endothelial Growth Factor Receptor-1 / Q000097:blood*; D055815:Young Adult
chemical_list: C000608036:PGF protein, human; D011257:Pregnancy Proteins; D000072483:Placenta Growth Factor; C501162:FLT1 protein, human; D040281:Vascular Endothelial Growth Factor Receptor-1
keywords: Angiogenic factors; Placenta; Placental lesions.