Maternal serum sFlt‐1/PlGF ratio in twin pregnancies with and without pre‐eclampsia in comparison with singleton pregnancies

L Dröge, I Herraìz, H Zeisler… - … in Obstetrics & …, 2015 - Wiley Online Library
L Dröge, I Herraìz, H Zeisler, D Schlembach, H Stepan, L Küssel, W Henrich, A Galindo
Ultrasound in Obstetrics & Gynecology, 2015Wiley Online Library
Objective In singleton pregnancies, soluble fms‐like tyrosine kinase‐1 (sFlt‐1), placental
growth factor (PlGF) and the sFlt‐1/PlGF ratio have shown utility as a diagnostic test for pre‐
eclampsia (PE). The objective of this study was to characterize the maternal serum levels of
sFlt‐1, PlGF and sFlt‐1/PlGF ratio in normal and pre‐eclamptic twin pregnancies. Methods In
a European multicenter case–control study, 49 women with a twin pregnancy were enrolled,
including 31 uneventful and 18 pre‐eclamptic pregnancies. sFlt‐1 and PlGF were measured …
Objective
In singleton pregnancies, soluble fms‐like tyrosine kinase‐1 (sFlt‐1), placental growth factor (PlGF) and the sFlt‐1/PlGF ratio have shown utility as a diagnostic test for pre‐eclampsia (PE). The objective of this study was to characterize the maternal serum levels of sFlt‐1, PlGF and sFlt‐1/PlGF ratio in normal and pre‐eclamptic twin pregnancies.
Methods
In a European multicenter case–control study, 49 women with a twin pregnancy were enrolled, including 31 uneventful and 18 pre‐eclamptic pregnancies. sFlt‐1 and PlGF were measured and receiver–operating characteristics (ROC) analysis was performed. The median sFlt‐1 and PlGF serum concentrations and sFlt‐1/PlGF ratio were compared with those of a singleton cohort, matched for gestational age, with PE (n = 54) and with an uncomplicated pregnancy outcome (n = 238).
Results
In twin pregnancies with PE, sFlt‐1 levels and the sFlt‐1/PlGF ratio were increased and PlGF levels were decreased as compared with those of twin gestations with an uneventful pregnancy outcome (20 011.50 ± 2330.35 pg/mL vs 4503.00 ± 2012.05 pg/mL (P ≤ 0.001), 164.22 ± 31.35 vs 13.29 ± 319.64 (P ≤ 0.001), and 138.80 ± 20.04 pg/mL vs 403.00 ± 193.10 pg/mL (P ≤ 0.001), respectively). The sFlt‐1/PlGF ratio did not differ between twin pregnancies with PE and singleton pregnancies with PE. In twin pregnancies with an uneventful outcome, sFlt‐1 levels and sFlt‐1/PlGF ratio were increased, but no differences in PlGF concentration were found when compared with that of singleton controls. ROC analysis determined 53 as an optimal cut‐off of the sFlt‐1/PlGF ratio for diagnosing PE in twin gestations, yielding a sensitivity of 94.4% and a specificity of 74.2%. The cut‐off values established for singleton pregnancies, of 33 and 85, led to sensitivities of 100% and 83.3%, and specificities of 67.7% and 80.6%, when used to detect PE in twin pregnancies.
Conclusions
Significant differences in the serum marker levels in singleton vs twin pregnancies were detected. Reference ranges of sFlt‐1, PlGF and their ratio in singleton pregnancies are therefore not transferable to twin pregnancies. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.
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