title: Circulating Angiogenic Factors and the Risk of Adverse Outcomes among Haitian Women with Preeclampsia.
abstract: OBJECTIVE
  Angiogenic factors are strongly associated with adverse maternal and fetal outcomes among women with preterm preeclampsia (PE) in developed countries. We evaluated the role of angiogenic factors and their relationship to adverse outcomes among Haitian women with PE.
  
  
  METHODS
  We measured plasma antiangiogenic soluble fms-like tyrosine kinase 1 (sFlt1) and proangiogenic placental growth factor (PlGF) levels in women with PE (n=35) compared to controls with no hypertensive disorders (NHD) (n=43) among subjects with singleton pregnancies that delivered at Hospital Albert Schweitzer (HAS) in Haiti. We divided the preeclamptic women into two groups, early onset (≤ 34 weeks) and late onset (>34 weeks) and examined relationships between sFlt1/PlGF ratios on admission and adverse outcomes (abruption, respiratory complications, stroke, renal insufficiency, eclampsia, maternal death, birth weight <2500 grams, or fetal/neonatal death) in women with PE subgroups as compared to NHD groups separated by week of admission. Data are presented as median (25th-75th centile), n (%), and proportions.
  
  
  RESULTS
  Among patients with PE, most (24/35) were admitted at term. Adverse outcome rates in PE were much higher among the early onset group compared to the late onset group (100.0% vs. 54.2%, P=0.007). Plasma angiogenic factors were dramatically altered in both subtypes of PE. Angiogenic factors also correlated with adverse outcomes in both subtypes of PE. The median sFlt1/PlGF ratios for subjects with early onset PE with any adverse outcome vs. NHD <=34 weeks with no adverse outcome were 703.1 (146.6, 1614.9) and 9.6 (3.5, 58.6); P<0.001). Among late onset group the median sFlt1/PlGF ratio for women with any adverse outcome was 130.7 (56.1, 242.6) versus 22.4 (10.2, 58.7; P=0.005) in NHD >34 weeks with no adverse outcome.
  
  
  CONCLUSIONS
  PE-related adverse outcomes are common in women in Haiti and are associated with profound angiogenic imbalance regardless of gestational age at presentation.
authors.affiliation: Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, United States of America; Division of Maternal Fetal Medicine/Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States of America.
authors.forename: Melissa I
authors.initials: MI
authors.lastname: March
authors.affiliation: Center for Vascular Biology and Research, Beth Israel Deaconess Medical Center Boston, MA, United States of America.
authors.forename: Carl
authors.initials: C
authors.lastname: Geahchan
authors.affiliation: Division of Nephrology/Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America.
authors.forename: Julia
authors.initials: J
authors.lastname: Wenger
authors.affiliation: Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, United States of America.
authors.forename: Nandini
authors.initials: N
authors.lastname: Raghuraman
authors.affiliation: Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States of America.
authors.forename: Anders
authors.initials: A
authors.lastname: Berg
authors.affiliation: Savjani Institute for Health Research, Windham, ME, United States of America.
authors.forename: Hamish
authors.initials: H
authors.lastname: Haddow
authors.affiliation: Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, United States of America.
authors.forename: Bri Ann
authors.initials: BA
authors.lastname: Mckeon
authors.affiliation: Department of Obstetrics and Gynecology, Hospital Albert Schweitzer, Deshapelles, Haiti.
authors.forename: Rulx
authors.initials: R
authors.lastname: Narcisse
authors.affiliation: Department of Obstetrics and Gynecology, Hospital Albert Schweitzer, Deshapelles, Haiti.
authors.forename: Jean Louis
authors.initials: JL
authors.lastname: David
authors.affiliation: Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, United States of America; Division of Women's Health/Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States of America.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Scott
authors.affiliation: Division of Nephrology/Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America.
authors.forename: Ravi
authors.initials: R
authors.lastname: Thadhani
authors.affiliation: Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, United States of America; Division of Maternal Fetal Medicine/Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States of America; Center for Vascular Biology and Research, Beth Israel Deaconess Medical Center Boston, MA, United States of America; Division of Nephrology/Department of Medicine, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, MA, United States of America; Howard Hughes Medical Institute, Boston, MA, United States of America.
authors.forename: S Ananth
authors.initials: SA
authors.lastname: Karumanchi
authors.affiliation: Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, United States of America; Division of Maternal Fetal Medicine/Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States of America; Maternal Fetal Medicine/Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, United States of America.
authors.forename: Sarosh
authors.initials: S
authors.lastname: Rana
mesh_terms: D001724:Birth Weight; D005260:Female; D005313:Fetal Death; D005865:Gestational Age; D006205:Haiti; D006801:Humans; D007231:Infant, Newborn; D000072483:Placenta Growth Factor; D011225:Pre-Eclampsia / Q000097:blood* / Q000503:physiopathology; D011247:Pregnancy; D011256:Pregnancy Outcome; D011257:Pregnancy Proteins / Q000097:blood*; 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