Angiogenic factor abnormalities and risk of peripartum complications and prematurity among urban predominantly obese parturients with chronic hypertension

•Study included predominantly obese African American women with chronic hypertension.•Women with sFlt1/PlGF ≥ 85 had a higher rate of adverse maternal outcomes.•Women with sFlt1/PlGF ≥ 85 delivered at younger gestational ages.•sFlt1/PlGF ≥ 85 was associated with postpartum hypertension and longer le...

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Published inPregnancy hypertension Vol. 20; pp. 124 - 130
Main Authors Heimberger, Sarah, Mueller, Ariel, Ratnaparkhi, Rubina, Perdigao, Joana Lopes, Rana, Sarosh
Format Journal Article
LanguageEnglish
Published Netherlands Elsevier B.V 01.04.2020
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Summary:•Study included predominantly obese African American women with chronic hypertension.•Women with sFlt1/PlGF ≥ 85 had a higher rate of adverse maternal outcomes.•Women with sFlt1/PlGF ≥ 85 delivered at younger gestational ages.•sFlt1/PlGF ≥ 85 was associated with postpartum hypertension and longer length of stay. To compare characteristics and outcomes of women with chronic hypertension (cHTN) between those with normal and abnormal plasma angiogenic profiles. This secondary analysis explored associations between angiogenic markers soluble fms-like tyrosine kinase-1 (sFlt1) and placental growth factor (PlGF) drawn prior to delivery among women with history of cHTN who were enrolled between 22 and 41 weeks. Patients were divided into two groups based on sFlt1/PlGF ratio, namely low sFlt1/PlGF (<85) and high sFlt1/PlGF (≥85) ratio. Of the 115 patients, 76% were African American. Compared to women with low sFlt1/PlGF (n = 78), patients with high sFlt1/PlGF (n = 37) had higher median antenatal blood pressures (systolic mmHg 179 vs 155; diastolic 106 vs 91), lower gestational age at delivery (34.7 vs 38.2 weeks), lower birthweight (1940 vs 3103 g), and a higher prevalence of preterm delivery <34 (40.5% vs 7.7%) and <37 weeks (64.9% vs 20.5%), all p < 0.001. Importantly, more women with high sFlt1/PlGF had a diagnosis of superimposed preeclampsia (62.2% vs 26.9%, p = 0.003), preeclampsia with severe features (59.5% vs 20.5%, p < 0.0001), maternal adverse outcomes (24.3% vs 3.9%, p = 0.002), neonatal intensive care unit admissions (71.9% vs 40.8%; p = 0.003), severe postpartum hypertension (67.6% vs 38.5%, p = 0.01) and longer hospital stays (median 6.0 vs 4.5 days, p = 0.003). In contrast to patients with a low ratio, high sFlt1/PlGF is characterized by an increased risk of maternal adverse outcomes and prematurity. Incorporation of angiogenic biomarkers while managing cHTN may improve accuracy of early identification of adverse outcomes to improve outcomes.
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ISSN:2210-7789
2210-7797
DOI:10.1016/j.preghy.2020.04.004