title: Role of vitamin D and sFlt-1/PlGF ratio in the development of early- and late-onset preeclampsia.
abstract: BACKGROUND
  The imbalanced production of placental biomarkers and vitamin D deficiency have been proposed as risk factors for the development of preeclampsia (PE). However, little is known about the relationship between them and their role in early- versus late-onset PE. The objectives were to assess the role of 25-hydroxyvitamin D [25(OH)D] concentrations and the soluble fms-like tyrosine kinase 1 (sFlt-1) to placental growth factor (PlGF) ratio in the development of early- and late-onset PE; and to evaluate the relationship between 25(OH)D and the biomarkers.
  
  
  METHODS
  A retrospective, full-blinded cohort study was conducted at the Obstetric Emergency Service of a tertiary care hospital. Pregnant women (n=257) attending obstetric triage with suspicion of PE were included. sFlt-1, PlGF and 25(OH)D concentrations were measured by electrochemoluminescence (ECLIA) immunoassay and pregnancy outcome (development of PE) was registered from patients records.
  
  
  RESULTS
  PE women showed lower 25(OH)D concentrations at clinical presentation than non-PE women (median: 35.0 nmol/L and 39.6 nmol/L, respectively; p=0.027). Women with 25(OH)D levels <50 nmol/L experienced an increased risk of developing late-onset PE [odds ratio (OR) 4.6, 95% confidence interval (CI) 1.4-15], but no association was found for early-onset PE. However, a sFlt-1/PlGF ratio above the corresponding cutpoints increased the risk of developing both early- and late-onset PE [ORs 58 (95% CI 11-312) and 12 (95% CI 5.0-27), respectively]. No association was found between 25(OH)D levels and sFlt-1/PlGF ratio.
  
  
  CONCLUSIONS
  Low vitamin D status in women with suspected late-onset PE increases the risk of imminent development of the disease.
authors.forename: Indira
authors.initials: I
authors.lastname: Álvarez-Fernández
authors.forename: Belén
authors.initials: B
authors.lastname: Prieto
authors.forename: Verónica
authors.initials: V
authors.lastname: Rodríguez
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Ruano
authors.forename: Ana I
authors.initials: AI
authors.lastname: Escudero
authors.forename: Francisco V
authors.initials: FV
authors.lastname: Álvarez
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000378:metabolism; D005260:Female; D006801:Humans; D000072483:Placenta Growth Factor; D011225:Pre-Eclampsia / Q000378:metabolism*; D011247:Pregnancy; D011257:Pregnancy Proteins / Q000378:metabolism*; D012189:Retrospective Studies; D013997:Time Factors; D040281:Vascular Endothelial Growth Factor Receptor-1 / Q000378:metabolism*; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000378:metabolism
chemical_list: D015415:Biomarkers; C000608036:PGF protein, human; D011257:Pregnancy Proteins; D014807:Vitamin D; D000072483:Placenta Growth Factor; C104450:25-hydroxyvitamin D; C501162:FLT1 protein, human; D040281:Vascular Endothelial Growth Factor Receptor-1