title: Predictive value of angiogenic factors, clinical risk factors and uterine artery Doppler for pre-eclampsia and fetal growth restriction in second and third trimester pregnancies in an Ecuadorian population.
abstract: OBJECTIVE
  To evaluate the performance of angiogenic factors, maternal risks and uterine artery Doppler (UAD) in the prediction of pre-eclampsia (PE) and fetal growth restriction (FGR) in a high-risk Ecuadorian population.
  
  
  METHODS
  Patients with singleton pregnancies (n = 346) were investigated at two clinical visits (18-25 weeks and 28-32 weeks). Mean uterine artery (UA), pulsatility index (PI) and maternal biomarkers (soluble fms-like tyrosine kinase-1, placental growth factor, sFlt-1/PLGF ratio) were obtained. The main endpoints were PE and FGR. UA PI and angiogenic factor levels were compared for the groups with PE (n = 34), FGR (n = 26), PE & FGR (n = 14) and controls (n = 272). Multivariable stepwise logistic regression was used to construct prediction models.
  
  
  RESULTS
  Pregnancies with either FGR or PE & FGR exhibited in the second trimester a significantly higher mean UA PI and sFlt-1/PLGF ratio and lower PLGF values compared to controls. In the third trimester, all groups with adverse outcome demonstrated significantly lower PLGF levels and a higher sFlt-1/PLGF ratio compared to normal pregnancies. Differences were most pronounced for pregnancies that developed PE and FGR for both time intervals. The combination of UAD and sFlt-1/PLGF ratio improved the predictive capacity for PE and FGR compared to each parameter alone. The best performance was obtained by integrating anamnestic risk factors, resulting in an area under the receiver operating curve for PE of 0.85 and 0.89 and for FGR of 0.79 and 0.77 in the second and third trimester, respectively.
  
  
  CONCLUSIONS
  In a high-altitude Ecuadorian population, angiogenic factors and UA PI were useful tools in the prediction of PE and/or FGR. The highest performance was achieved by the combination of these factors, including obstetric and medical history.
authors.affiliation: a Department of Obstetrics and Gynecology , Marienhaus Klinikum St. Elisabeth , Neuwied , Bonn , Germany .
authors.forename: Carolin
authors.initials: C
authors.lastname: Kienast
authors.affiliation: b Faculty of Medicine , Universidad Central del Ecuador , Quito , Ecuador .
authors.forename: Walter
authors.initials: W
authors.lastname: Moya
authors.affiliation: c Roche Diagnostics Ecuador , Quito , Ecuador .
authors.forename: Oswaldo
authors.initials: O
authors.lastname: Rodriguez
authors.affiliation: d Faculty of Medicine , Pontificia Universidad Catolica del Ecuador , Quito , Ecuador , and.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Jijón
authors.affiliation: e Department of Obstetrics and Prenatal Medicine , University of Bonn , Bonn , Germany.
authors.forename: Annegret
authors.initials: A
authors.lastname: Geipel
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D015331:Cohort Studies; D004484:Ecuador; D005260:Female; D005317:Fetal Growth Retardation / Q000175:diagnosis*; D006801:Humans; D015999:Multivariate Analysis; D000072483:Placenta Growth Factor; D011225:Pre-Eclampsia / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011257:Pregnancy Proteins / Q000097:blood*; D011262:Pregnancy Trimester, Second / Q000097:blood; D011263:Pregnancy Trimester, Third / Q000097:blood; D012307:Risk Factors; D012680:Sensitivity and Specificity; D018608:Ultrasonography, Doppler; D055988:Uterine Artery / Q000000981:diagnostic imaging*; D040281:Vascular Endothelial Growth Factor Receptor-1 / Q000097:blood*; D055815:Young Adult
chemical_list: D015415:Biomarkers; 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; Ecuador; fetal growth restriction; high altitude; placental growth factor; pre-eclampsia; soluble fms-like tyrosine kinase-1; uterine artery Doppler