RESUMO
INTRODUCTION: The circulating concentration of PlGF is reported to be lower in patients experiencing preeclampsia and patients delivering a small for gestational age (SGA) neonate. OBJECTIVES: To evaluate the predictive value of circulating PlGF for preeclampsia and adverse outcome in patients with suspected preeclampsia or fetal growth restriction. METHODS: We prospectively enrolled 96 women who were included after 22 weeks gestation (WG) for suspected preeclampsia or suspected SGA, and measured plasma levels of PlGF (Triage® PLGF, Alere©) at enrollment. We studied outcome until delivery and one week postpartum, and defined adverse outcome as severe preeclampsia, SGA neonate (<10th centile) or elective delivery for maternal or fetal complication. Severe adverse outcome was studied among patients included <34WG and defined as eclampsia, HELLP syndrome, very SGA (<3rd centile) or elective delivery <34WG. RESULTS: The mean logtransformed PlGF level was lower for women who experienced preeclampsia than for those who did not (2.9 vs 3.7, p=0.02), and was markedly lower for patients who experienced adverse outcome (2.9 vs 4.3, p<0.001). The odds of presenting an adverse outcome were higher for the lowest tertile of PlGF compared to the higher (OR=12 , 95% CI [3-46] ). Among patients included <34WG, the odds of experiencing a severe adverse outcome were, respectively, for the lowest and intermediate tertile as compared with the higher tertile: OR=132 , 95% CI [14-1273]; and OR=20, 95% CI [4-106] . When included <34 WG, patients with a PlGF level <12pg/ml experienced a severe adverse outcome in 96% of cases (24/25), and only 1 of 28 patients with a PlGF level >50pg/ml experienced a severe adverse outcome within 15 days (4%). Among women with suspected SGA who were enrolled <32WG and whose PlGF level was <12pg/ml, 89% had an elective delivery before 34 WG (17/19). CONCLUSION: Among women with suspected preeclampsia or SGA, PlGF circulating levels differ between women who will experience an adverse outcome and those who will not. It can therefore be of help in the management of these patients, especially for those for whom the diagnosis is suspected early in pregnancy.