The effect of comorbidities on the sFLT-1: PlGF ratio in preeclampsia

Pre-eclampsia affects 2-5% of pregnancies, causing significant maternal and perinatal morbidity and mortality.[1]

The pathogenesis of preeclampsia remains incompletely understood. Its characteristic hypertension and organ-dysfunction arise secondary to widespread endothelial dysfunction and vasoconstriction.[2] Evidence increasingly suggests a role for the angiogenic biomarkers soluble fms-like tyrosine kinase-1 (sFLT-1) and placental growth factor (PlGF), which are, respectively, increased and decreased in preeclampsia.[3] sFLT-1 is released from the ischemic placenta, antagonising and sequestering the pro-angiogenic PLGF and vascular endothelial growth factor, contributing to endothelial dysfunction [4]

Vascular risk factors, including medical comorbidities such as chronic hypertension, diabetes mellitus chronic kidney disease (CKD) and systemic lupus erythematosus (SLE), increase the risk of women developing preeclampsia.[5], [6], [7], [8], [9]

There is sparse evidence guiding the clinical diagnosis of preeclampsia when preexisting hypertension and/or proteinuria are present, as is common for women with these comorbidities, due to the diagnostic challenge preeclampsia poses. Similarly, there is limited research evaluating how useful sFLT-1 and PlGF, which are entering clinical decision making guidelines, [10] are in the diagnosis of preeclampsia for these women. Women with vascular risk factors are prone to pre-existing endothelial dysfunction. They thus may develop clinical preeclampsia with a milder imbalance between sFLT-1 and PlGF.[11]

While several studies [12], [13] have demonstrated that, among women with these comorbidities, these biomarkers are elevated when preeclampsia develops, sparse research has compared the magnitude of their elevation between women with and without comorbidities. Data from studies on women without vascular risk factors, which forms the basis for new guidelines, may not be applicable for women with comorbidities. We undertook a prospective cohort study to compare the sFLT-1: PlGF ratio between women with and without comorbidities, who did and did not develop preeclampsia.

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