Abstract Objectives The sFlt-1/PlGF ratio is a predictive biomarker for preeclampsia (PE)–related outcomes. In women with signs of PE at ≤34 weeks, it may guide the timing of antenatal corticosteroid (ACS) administration. Methods We retrospectively analyzed 702 women presenting with signs of PE and/or fetal growth restriction (FGR) between 22+0- and 33+6-weeks. High risk was defined as an sFlt-1/PlGF ratio ≥85. The predictive accuracy of the ratio for PE-related preterm birth at ≤34+0 weeks was assessed using receiver operating characteristic (ROC) analysis. Differences in remaining pregnancy duration and gestational age at delivery between risk groups were analyzed using the log-rank test (p<0.05). Results Among 702 patients, 165 (23.5 %) had a PE-related delivery ≤34+0 weeks. A high sFlt-1/PlGF ratio (≥85) was observed in 128 (18.2 %) women who received ACS and in 44 (6.3 %) who didn’t. The sFlt-1/PlGF ratio predicted PE-related delivery at ≤34+0 weeks – and thus the need for ACS with an AUC of 0.95 (95 % CI 0.93–0.97), yielding an optimal cut-off of 52.5 with sensitivity 87.9 % (95 % CI 82.0–92.0) and specificity 87.9 % (95 % CI 84.9–90.4). The median remaining pregnancy duration was 7.0 days (IQR 3.0–17.8), with delivery at 29+5 weeks (IQR 26+6–32+0) in women with ACS and a ratio ≥85, vs. 60.0 days (IQR 42.0–80.0) and delivery at 38+1 weeks (IQR 37+0–39+3) in women with a ratio <85 and no ACS. Conclusions In women with signs of PE and FGR <34 weeks of gestation, the sFlt-1/PlGF ratio is a strong predictor of PE-related preterm delivery and may support clinical decision-making regarding timely ACS administration.
Lorenz-Meyer et al. (Wed,) studied this question.
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