title: Preeclampsia and superimposed preeclampsia: The same disease? The role of angiogenic biomarkers.
abstract: OBJECTIVE
  We aimed to compare sFlt-1 and placental growth factor (PlGF) levels and the sFlt-1/PlGF ratio between women with preeclampsia and superimposed preeclampsia to, respectively, normotensive and chronic hypertensive ones.
  
  
  METHODS
  We performed a prospective two-armed cohort in a tertiary teaching hospital in Sao Paulo, Brazil, including 37 normotensive and 60 chronic hypertensive pregnant women. We assessed the serum levels of sFlt-1 and PlGF at 20, 26, 32, and 36 gestational weeks by enzyme-linked immunosorbent assay.
  
  
  METHODS
  Having preeclampsia and superimposed preeclampsia.
  
  
  RESULTS
  Among normotensive and chronic hypertensive pregnancies, 4 (10.8%) and 14 (23.3%) women developed preeclampsia and superimposed preeclampsia, respectively. Compared with those who remained normotensive, the preeclampsia women presented higher sFlt-1 levels at 32 gestational weeks (4323.45 pg/mL vs. 2242.04 pg/mL, p = 0.019), lower PlGF levels at 20 (183.54 pg/mL vs. 337.38 pg/mL, p = 0.034), 32 (169.69 pg/mL vs. 792.53 pg/mL, p = 0.001), and 36 gestational weeks (252.99 pg/mL vs. 561.81 pg/mL, p = 0.029), and higher sFlt-1/PlGF ratios at 26 (9.02 vs. 1.84, p = 0.004), 32 (23.61 vs. 2.55, p = 0.001), and 36 gestational weeks (49.02 vs. 7.34, p = 0.029). On the other hand, compared with those who remained chronic hypertensive, the superimposed preeclampsia women only presented a higher sFlt-1/PlGF ratio at 32 gestational weeks (9.98 vs. 2.51, p = 0.039).
  
  
  CONCLUSIONS
  Although angiogenic imbalance is clearly related to preeclampsia, it seems to play a more modest role in superimposed preeclampsia, in which other mechanisms should also be investigated.
authors.affiliation: a Department of Obstetrics and Gynecology of Faculdade de Medicina da Universidade de São Paulo , Sao Paulo , SP , Brazil.
authors.forename: Rafaela A
authors.initials: RA
authors.lastname: Costa
authors.affiliation: a Department of Obstetrics and Gynecology of Faculdade de Medicina da Universidade de São Paulo , Sao Paulo , SP , Brazil.
authors.forename: Mara S
authors.initials: MS
authors.lastname: Hoshida
authors.affiliation: b Department of Obstetrics and Gynecology of Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , Sao Paulo , SP , Brazil.
authors.forename: Eliane A
authors.initials: EA
authors.lastname: Alves
authors.affiliation: a Department of Obstetrics and Gynecology of Faculdade de Medicina da Universidade de São Paulo , Sao Paulo , SP , Brazil.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Zugaib
authors.affiliation: a Department of Obstetrics and Gynecology of Faculdade de Medicina da Universidade de São Paulo , Sao Paulo , SP , Brazil.
authors.forename: Rossana P V
authors.initials: RP
authors.lastname: Francisco
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D001938:Brazil; D005260:Female; D006801:Humans; D008875:Middle Aged; D000072483:Placenta Growth Factor / Q000097:blood*; D011225:Pre-Eclampsia / Q000097:blood / Q000175:diagnosis*; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011446:Prospective Studies; D040281:Vascular Endothelial Growth Factor Receptor-1 / Q000097:blood*; D055815:Young Adult
chemical_list: D015415:Biomarkers; D000072483:Placenta Growth Factor; D040281:Vascular Endothelial Growth Factor Receptor-1
keywords: Angiogenic factors; hypertension; preeclampsia; pregnancy