Transactions of the Twenty-Fifth Annual Meeting of the Society for Maternal-Fetal Medicine
An elevated maternal plasma, but not amniotic fluid, soluble fms-like tyrosine kinase-1 (sFlt-1) at the time of mid-trimester genetic amniocentesis is a risk factor for preeclampsia

https://doi.org/10.1016/j.ajog.2005.06.033Get rights and content

Objective

The purpose of this study was to determine if an elevated concentration of soluble fms-like tyrosine kinase-1(sFlt-1) in maternal plasma and amniotic fluid is a risk factor for the subsequent development of preeclampsia.

Study design

A case-control study was conducted to compare mid-trimester concentrations of maternal plasma and amniotic fluid sFlt-1 in patients who developed preeclampsia with those who did not. The study included 32 cases with preeclampsia (18 cases: severe preeclampsia) and 128 matched controls with normal outcomes. Patients with an abnormal fetal karyotype or major anomaly, multiple pregnancies, chronic hypertension, diabetes, and renal disease were excluded. Soluble Flt-1 concentration was measured by specific immunoassay. Nonparametric techniques were used for statistical analysis.

Results

1) The median maternal plasma, but not amniotic fluid, sFlt-1 concentration in patients who developed preeclampsia was significantly higher than in the control cases (maternal plasma: median 730 pg/mL, range 60-3375 pg/mL vs median 441 pg/mL, range 58-1959 pg/mL, P < .05; amniotic fluid: median 10,504 pg/mL, range 5253-38,023 pg/mL vs median 10,236 pg/mL, range 4326-87,684 pg/mL, P = .65). 2) The median plasma concentration of sFlt-1 was higher in cases of severe preeclampsia than in those with mild preeclampsia without reaching statistical significance (median 762 pg/mL, range 261-3309 pg/mL vs median 334 pg/mL, range 60-3375 pg/mL; P = .07). However, there was no significant difference in the median amniotic fluid sFlt-1 concentrations between patients with severe preeclampsia and those with mild preeclampsia (P = .45). 3) An elevated maternal plasma sFlt-1 concentration (higher than 700 pg/mL) is a risk factor for the development of preeclampsia (OR 3.9, 95% CI 1.7-8.6) and severe preeclampsia (OR 7.4, 95% CI 2.5-22.1) after genetic amniocentesis. 4) The median interval from amniocentesis to the diagnosis of preeclampsia in patients with maternal plasma sFlt-1 concentrations higher than 700 pg/mL was 117 days (range 19-154 days).

Conclusion

An elevated concentration of sFlt-1 in maternal plasma at the time of mid-trimester amniocentesis is a risk factor for the subsequent development of preeclampsia.

Section snippets

Study design

A case-control study was designed with stored amniotic fluid and maternal plasma obtained from women who underwent mid-trimester genetic amniocentesis between July 1998 and April 2004 at Seoul National University Hospital in Seoul, Korea. The case group consisted of pregnant women who subsequently developed preeclampsia. The control group consisted of women who had a normal pregnancy outcome (term gestation with a neonate with adequate weight for gestational age).

Thirty-two patients who

Results

The clinical characteristics of the study population are shown in Table I. There were no statistically significant differences in the mean maternal age, parity, gestational age at amniocentesis and blood sampling, indication for amniocentesis, maternal weight, and body mass index between patients who developed preeclampsia and those in the control group.

Table II demonstrates the clinical characteristics of patients with preeclampsia at the time of diagnosis. Among cases with preeclampsia, 18

Comment

Our data indicate that the median mid-trimester maternal plasma sFlt-1 concentration in patients who subsequently developed preeclampsia was significantly higher than in those who had a normal pregnancy outcome and an elevated maternal plasma sFlt-1 concentration (higher than 700 pg/mL) is associated with an increased risk for the development of severe preeclampsia (OR 7.4, 95% CI 2.5-22.1).

As to the mean sFlt-1 concentration of normal pregnant women, there are some variations among several

References (19)

There are more references available in the full text version of this article.

Cited by (0)

This study was supported by a grant 01-PJ1-PG1-01CH07-0002 from the 2001 Korea Health 21 R&D Project, Ministry of Health and Welfare, Republic of Korea.

Presented at the Twenty-Fifth Annual Meeting of the Society for Maternal Fetal Medicine, February 7-12, 2005, Reno, Nev.

View full text