Predictive value of angiogenic factors, clinical risk factors and uterine artery Doppler for pre-eclampsia and fetal growth restriction in second and third trimester pregnancies in an Ecuadorian population

摘要

Objective: To evaluate the performance of angiogenic factors, maternal risks and uterine arteryDoppler (UAD) in the prediction of pre-eclampsia (PE) and fetal growth restriction (FGR) in ahigh-risk Ecuadorian population.Methods: Patients with singleton pregnancies (n¼346) were investigated at two clinical visits(18–25 weeks and 28–32 weeks). Mean uterine artery (UA), pulsatility index (PI) and maternalbiomarkers (soluble fms-like tyrosine kinase-1, placental growth factor, sFlt-1/PLGF ratio) wereobtained. The main endpoints were PE and FGR. UA PI and angiogenic factor levels werecompared for the groups with PE (n¼34), FGR (n¼26), PE & FGR (n¼14) and controls(n¼272). Multivariable stepwise logistic regression was used to construct prediction models.Results: Pregnancies with either FGR or PE & FGR exhibited in the second trimester asignificantly higher mean UA PI and sFlt-1/PLGF ratio and lower PLGF values compared tocontrols. In the third trimester, all groups with adverse outcome demonstrated significantlylower PLGF levels and a higher sFlt-1/PLGF ratio compared to normal pregnancies. Differenceswere most pronounced for pregnancies that developed PE and FGR for both time intervals. Thecombination of UAD and sFlt-1/PLGF ratio improved the predictive capacity for PE and FGRcompared to each parameter alone. The best performance was obtained by integratinganamnestic risk factors, resulting in an area under the receiver operating curve for PE of 0.85and 0.89 and for FGR of 0.79 and 0.77 in the second and third trimester, respectively.Conclusion: In a high-altitude Ecuadorian population, angiogenic factors and UA PI were usefultools in the prediction of PE and/or FGR. The highest performance was achieved by thecombination of these factors, including obstetric and medical history.