Clinical utility of sFlt-1 and PlGF in screening, prediction, diagnosis and monitoring of pre-eclampsia and fetal growth restriction.

Stepan, H; Galindo, A; Hund, M; Schlembach, D; Sillman, J; Surbek, D; Vatish, M (2023). Clinical utility of sFlt-1 and PlGF in screening, prediction, diagnosis and monitoring of pre-eclampsia and fetal growth restriction. Ultrasound in obstetrics & gynecology, 61(2), pp. 168-180. Wiley 10.1002/uog.26032

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Preeclampsia (PE) is characterized by placental and maternal endothelial dysfunction, and associated with fetal growth restriction (FGR), placental abruption, preterm delivery and stillbirth. The angiogenic factors soluble fms-like tyrosine kinase 1 (sFlt-1) and placental growth factor (PlGF) are altered in pregnancies complicated by placental-related disorders. In this review, we summarize existing literature examining the performance of maternal PlGF, sFlt-1 and sFlt-1/PlGF ratio for a) screening and diagnosing PE, b) predicting PE development in the short term, c) monitoring established PE and d) predicting other placental-related disorders. We also discuss the performance of PlGF and the sFlt-1/PlGF ratio for predicting PE in twin pregnancies. For first trimester screening, a more accurate way of identifying high-risk women than current practices is to combine PlGF levels with clinical risk factors and ultrasound markers. To support diagnosis of PE later in pregnancy, the sFlt-1/PlGF ratio has advantages over PlGF because it has a higher pooled sensitivity and specificity for diagnosing and monitoring PE. The sFlt-1/PlGF ratio has clinical value because it can rule out the development of PE in the subsequent 1-4 weeks after the test. Once diagnosis of PE is established, repeated measurement of sFlt-1 and PlGF can help monitor progression of the condition and may inform clinical decision-making around optimal time for delivery. The sFlt-1/PlGF ratio is useful for predicting FGR and preterm delivery, but the association between stillbirth and the angiogenic factors remains unclear. The sFlt-1/PlGF ratio can also be used to predict PE in twin pregnancies, although different sFlt-1/PlGF ratio cut-offs to those of singleton pregnancies should be applied for optimal performance. In summary, PlGF, sFlt-1 and the sFlt-1/PlGF ratio are useful for screening, diagnosing, predicting, and monitoring placental-related disorders in singleton and twin pregnancies; we propose further integration of these angiogenic factor tests in clinical practice. This article is protected by copyright. All rights reserved.

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