Clinical characterization and outcomes of preeclampsia with normal angiogenic profile

• Published in: Hypertension in pregnancy Vol. 32; no. 2; pp. 189 - 201
• Main Authors: Rana, Sarosh, Schnettler, William T., Powe, Camille, Wenger, Julia, Salahuddin, Saira, Cerdeira, Ana Sofia, Verlohren, Stefan, Perschel, Frank H., Arany, Zoltan, Lim, Kee-Hak, Thadhani, Ravi, Karumanchi, S. Ananth
• Format: Journal Article
• Language: English
• Published: England Informa Healthcare USA, Inc 01-05-2013; Taylor & Francis
• Subjects: Adult; Adverse outcomes; Angiogenic factors; Boston - epidemiology; Female; Humans; Neovascularization, Pathologic; Non-angiogenic preeclampsia; Placenta Growth Factor; Pre-Eclampsia - blood; Pre-Eclampsia - diagnosis; Pre-Eclampsia - epidemiology; Pregnancy; Pregnancy Proteins - blood; Premature Birth - epidemiology; Prospective Studies; Vascular Endothelial Growth Factor Receptor-1 - blood
• ISSN: 1064-1955; 1525-6065
• DOI: 10.3109/10641955.2013.784788

Objective: To compare the clinical characteristics and outcomes of preeclamptic women presenting with a normal plasma angiogenic profile with those subjects who are characterized by an abnormal angiogenic profile. Methods: This was a secondary analysis of a prospective cohort study in women presenting to obstetrical triage at <37 weeks of gestation and diagnosed with preeclampsia within 2 weeks of enrollment and in whom angiogenic factors (sFlt1 and PlGF) measurements were available. Patients were divided into two groups based on their circulating levels of these factors described as a ratio; the sFlt1/PlGF ratio, non-angiogenic preeclampsia (sFlt1/PlGF ratio <85) and angiogenic preeclampsia (sFlt1/PlGF ratio 85). The data are presented by sFlt1/PlGF category using median and quartile 1-quartile 3 for continuous variables and by frequency and sample sizes for categorical variables. Results: In our cohort, the patients with non-angiogenic preeclampsia (N = 46) were more obese [BMI: 35.2 (31.6, 38.7) versus 31.1 (28.0, 39.0), p = 0.04], more likely to have preexisting diabetes (21.7% versus 2.0%, p = 0.002) and presented at a later gestational age [35 (32, 37) versus 32 (29, 34) weeks, p < 0.0001] as compared with women with angiogenic preeclampsia (N = 51). Women with non-angiogenic preeclampsia had no serious adverse outcomes (elevated liver function tests/low platelets: 0% versus 23.5%, abruption: 0% versus 9.8%, pulmonary edema: 0% versus 3.9%, eclampsia: 0% versus 2.0 %, small for gestational age: 0% versus 17.7% and fetal/neonatal death: 0% versus 5.9%) as compared with women with angiogenic preeclampsia. The rate of preterm delivery <34 weeks was 8.7% in non-angiogenic preeclampsia compared with 64.7% in angiogenic preeclampsia (p < 0.0001). Interestingly, delivery between 34 and 37 weeks and resource utilization (hospital admission days) were similar in the two groups. Conclusion: In contrast to the angiogenic form, the non-angiogenic form of preeclampsia is characterized by little to no risk of preeclampsia-related adverse outcomes, other than iatrogenic prematurity. Incorporation of angiogenic biomarkers in the evaluation of preeclampsia may allow accurate and early identification of severe disease.