Role of placental, fetal and cardiovascular markers in predicting adverse outcomes in women with suspected or confirmed pre-eclampsia

STUDY OBJECTIVES: To assess the performance of placental, fetal and cardiovascular markers in the prediction of adverse outcomes in women with suspected or confirmed preeclampsia. METHODS: In this prospective prognostic accuracy study, women with suspected or confirmed preeclampsia underwent a series of investigations to measure maternal hemodynamic indices, mean arterial pressure (MAP), augmentation index (AIx), ophthalmic artery peak ratio (PR), uterine artery pulsatility index (UTA-PI), fetal biometry and Doppler studies, soluble fms-like tyrosine kinase-1 (sFLT-1), and placental growth factor (PlGF). The performance of these markers in isolation or in combination, to predict adverse perinatal outcomes and adverse maternal outcomes was then assessed using receiver-operating characteristics (AUROC) analysis. RESULTS: We included 126 women with suspected (n=31) or confirmed preeclampsia (n=95) with a median gestational age of recruitment of 33.9 weeks (interquartile range 30.9-36.3). Adverse perinatal outcomes were associated with a higher median UTA-PI (1.3 vs 0.8, p<0.001), ophthalmic artery PR (0.8 vs 0.7, p=0.01), and umbilical artery PI (82.0 vs 68.5 percentile, p<0.01), and lower median estimated fetal weight (4.0 vs 43.0 percentile, p<0.001), abdominal circumference (4.0 vs 63.0 percentile, p<0.001), middle cerebral artery PI (28.0 vs 58.5 percentile, p<0.001), and cerebroplacental ratio (18.0 vs 46.5 percentile, p<0.001). Pregnancies with adverse perinatal outcomes also had a higher median sFLT-1 (8208.0pg/mL vs 4508.0pg/mL, p<0.001), lower PlGF (27.2pg/mL vs 76.3pg/mL, p<0.001) and a higher sFLT-1/PlGF ratio (445.4 vs 74.4, p<0.001). The best performing individual marker for predicting adverse perinatal outcomes was the sFLT-1/PlGF ratio (AUROC 0.87, 95% CI 0.81-0.93) followed by estimated fetal weight (AUROC 0.81, 95% CI 0.73-0.89). Adverse maternal outcomes were associated with a higher median sFLT-1 (7471.0pg/mL vs 5131.0pg/mL, p<0.001), sFLT-1/PlGF ratio (204.3 vs ...