SFLT-1/PLGF Ratio and Hypertensive States of Pregnancy in Real Life: Analysing Risk of Preeclmapsia

Objective: To analyse the relationship between sFlt-1/PlGF ratio and the occurrence and severity of preeclampsia. Design and method: An observational, retrospective, cross-sectional study; collecting data of pregnant women who undergo sFlt-1/PlGF ratio determination between Jan-Sept 2022 in a tertiary hospital. We collected baseline characteristics, data related with the pregnancy, birth and development and severity of hypertensive disorders of pregnancy (HDP),as well as treatment at discharge. Results: Among 109 recruited patients, 5 were excluded due to loss of follow-up. We analysed 104 women (mean age of 33.9 years SD 5.0). 52.5% were primiparous, 10.6% had in vitro pregnancies and 4.8% had twins. Nearly all were non-diabetic (99%), with 11.5% developing gestational diabetes.7.7% had pre-pregnancy hypertension and 15.4% had prior HDP (68.8% of them were preeclampsia). 90.4% women breastfed. Other characteristics are specified in table 1. During pregnancy, 64.4% developed HDP, being the mean week of diagnosis 35.8 (SD 4.1): 45.2% presented pre-eclampsia (PE) / eclampsia; 4.8% had chronic hypertension and 14.4% had gestational hypertension. Just 18.3% received acetylsalicylic acid as prophylaxis. At discharge, 38.5% continued with antihypertensive treatment. The sFlt-1/PlGF median ratio was 43.7, (interquartile range 13.0-81.6) and a 53.9% obtained a pathological value (>38). It correctly classified PE in 77.9% cases, with a 83.7% sensitivity and 72.7% specificity. Positive and negative predictive values were 73.2% and 83.3% respectively. A pathological sFlt-1/PlGF ratio is associated with a higher risk of PE (OR 13.7 CI95% 13.2-35.8), regardless use of acetylsalicylic acid. Besides, when stratified it into tertiles, those patients with a range 26-63 (second tertil) had an OR of 6.5 1.9-22.4 while in the range >63 (third tertil)had an OR 45.0 11.0-184.0 vs first tertil: therefore the higher the ratio, the higher the risk of PE. Conclusions: The sFlt-1/PlGF ratio is an important tool to predict preeclampsia. A pathological sFlt-1/PlGFratio increases this risk of PE more than 13 times compared with a normal value. Moreover, the risk of PE increases as the ratio increases.