Angiogenic factors and uterine artery Doppler for prediction of pre-eclampsia in high-risk population

Objectives: To investigate the role of angiogenic factors (sFlt-1, PlGF) and uterine artery blood flow (mean PI and RI) for prediction of pre-eclampsia in high-risk population at 13, 22 and 27 wks of gestation. Methods: 194 women were examined 3 times during their pregnancy: at 11+0–13+6, 22+0–22+6 and 27+0–27+6 weeks of gestation. Each time uterine artery Doppler was performed and mean uterine artery PI (UaPI) and RI (UaRI) were calculated. Also at their 2nd and 3rd visit sFlt-1 and PlGF concentrations in the blood were measured.With the help of discriminant analysis best predictors of preterm, term and overall pre-eclampsia were excluded and their cut- off values with the help of ROC curve analysis calculated. Then logistic regression was performed to calculate the probability of each pre-eclampsia with different cut-off combinations of variables. Results: 17 patients developed pre-eclampsia: 8 had preterm and 9 - term pre-eclampsia. At 11+0–13+6 wks statistically significant prediction of preterm pre-eclampsia was achieved by mean UaRI (p=0.019). Its cut-off value >1.25 showed the sensitivity of 87.5% and specificity of 72.6%. At 22+0–22+6 wks the best predictors of preterm pre-eclampsia seemed to be PlGF, mean UaPI and UaRI (p<0.001). Combination of their cut-off values of≤133.1 pg/ml,>1.94 and>0.99 respectively showed the probability of preterm pre-eclampsia in 95.5%. At 27+0–27+6 wks the best predictors for preterm and term pre-eclampsia were sFlt-1/PlGF and mean UaPI. The ratio of sFlt-1/PlGF more than 10.7 alone predicted preterm pre-eclampsia with the sensitivity and specificity of 100% and overall pre-eclampsia with the sensitivity of 58.8% and specificity of 100%. Conclusions: At 11+0–13+6 wks mean UaRI can be helpful for prediction of pre-eclampsia in high risk population. At 22+0–22+6 wks of gestation with the help of PlGF, mean UaPI and mean UaRI 95.5% cases of preterm pre-eclampsia can be predicted. At 27+0–27+6 [...].