Real life outpatient biomarker use in management of hypertensive pregnancies in third trimester in a low resource SeTting: ROBUST study

• Published in: Pregnancy hypertension Vol. 23; pp. 97 - 103
• Main Authors: Soundararajan, Revathi, Suresh, Sunitha C., Mueller, Ariel, Heimberger, Sarah, Avula, Smitha, Sathyanarayana, Chaitra, Mahesh, Sunitha, Madhuprakash, Sushma, Rana, Sarosh
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01-03-2021
• Subjects: Angiogenic biomarker; Preeclampsia; Prenatal care; Risk assessment; Angiogenic biomarker; Preeclampsia; Risk assessment; Prenatal care
• ISSN: 2210-7789; 2210-7797
• DOI: 10.1016/j.preghy.2020.11.010

•We studied angiogenic proteins in pregnant hypertensive women in an Indian clinic.•sFlt1/PlGF ratio was used as adjunt to clinical care for risk assessment & management.•A sFlt1/PlGF ratio <33 had an NPV of 100% for severe preeclampsia in 1 week.•There was a longer latency to delivery among those with persistent low risk ratio.
The utility of angiogenic biomarkers in a low resource outpatient setting is not well known. This study evaluates the clinical utility of angiogenic biomarkers, soluble fms-like tyrosine kinase 1 (sFlt1) and placental growth factor (PlGF) among patients at risk for preeclampsia in a low resource outpatient setting.
This was a prospective pilot study among high risk third trimester outpatients conducted in Bengaluru, India. Serum sFlt1/PlGF was measured between 28 and 37 weeks. Patients with high risk ratio were managed with close observation, intermediate risk had serum redrawn in one week, and those with low risk ratio received routine care. Delivery decisions were made based on local protocols.
Maternal complication rate, development of preeclampsia with severe features, and latency to delivery was examined by sFlt1/PlGF ratio.
The study included 50 patients. Compared to women with a low risk ratio, women with a high-risk ratio were more likely to have preeclampsia with severe features (90.91% vs 8.00%, p < 0.0001), a higher composite maternal complication rate (18.18% vs 0%, p = 0.04) and deliver at earlier gestational ages (32.57 [30.43, 34.71] vs 37.43 [36.86, 38.14] weeks, p = 0.0001).
Angiogenic factors may have utility in the low resource outpatient setting for women with a hypertensive disease. Low sFlt1/PlGF levels were associated with a longer latency to delivery and no maternal complications. This study confirms the broad clinical utility of biomarkers in the real world.