Background sFlt-1/PlGF is a relatively recent biomarker for preeclampsia and for predicting adverse fetal outcomes. However, the marker has still not found its way in clinical practice in Pakistan. Objectives We aimed to determine positive and negative predictive values of sFlt-1/PIGF ratio for preeclampsia and its correlation with adverse fetal outcomes. Design Prospective cohort. Methods The study was conducted between September 2022 and January 2023. Blood samples for sFlt-1/PIGF ratio were taken from women at 28-30 weeks gestation with two or more risk factors of preeclampsia, and without known history of diabetes mellitus, hypertension, renal disease or hypothyroidism. Subjects were followed till delivery. Main outcome measures were negative predictive value (NPV) and positive predictive value (PPV) for sFlt-1/PIGF ratio and correlation of sFlt-1/PIGF ratio with adverse fetal outcomes. Results Out of total 180 women enrolled, 133(73.9%) had gestational diabetes mellitus (GDM), while 48(26.7%) had raised diastolic blood pressure at booking. sFlt-1/PlGF-ratio and its statistics were performed on 160 subjects. The ratio was ≤38 in 155 (96.8%) women. Preeclampsia was diagnosed in 12 participants. NPV of sFlt-1/PlGF ratio ≤38 to rule out Preeclampsia (PE) within a period of one week was 95.32% (95% CI 90.14%-97.84%) with sensitivity of 33.0% (95% CI 0.84%-90.57%) and specificity of 97.45% (95% CI 93.61%-99.30%). The PPV to rule in preeclampsia at the ratio cutoff of −38 within a period of 4 weeks was 41.18% (95% CI 9.03%-83.16%) with sensitivity of 25 (95% CI 0.63%-80.59%) and specificity of 97.44% (95% CI 93.57%-99.30%). Adverse fetal outcomes were seen in 43 (23.9%) deliveries, of which 7(16.3%) women were diagnosed to have preeclampsia. Women with adverse fetal outcomes had higher median (IQR) sFlt-1/PlGF ratio of 5.3(2.4-10.5), P -value = .008. There was a negative correlation of sFlt-1/PlGF-ratio with birthweight ( P value .000), gestational age at delivery, and Appearance, pulse, grimace, activity, respiration (APGAR) Scores. Conclusion sFlt-1/PlGF ratio can be used to rule out preeclampsia and predict adverse fetal outcomes. Wider scale studies are required to truly assess its sensitivity for preeclampsia.
Kanani et al. (Thu,) studied this question.