Hypertens Res. 2025 Oct 20. doi: 10.1038/s41440-025-02428-0. Online ahead of print.
ABSTRACT
We aimed to investigate the effects of serum sFlt-1/PlGF ratio levels in women with suspected or confirmed early-onset preeclampsia and super-imposed preeclampsia (PE/SPE) on composite and individual adverse maternal and fetal outcomes, stratified by gestational age at blood sampling (<34, 34-36, and ≥37 weeks). We also evaluated whether serum sFlt-1/PlGF ratio levels influenced the time interval from blood sampling to delivery. This prospective cohort study assessed serum levels of sFlt-1, PlGF, and the sFlt-1/PlGF ratio in women with suspected or confirmed PE/SPE admitted to a tertiary maternal-fetal-neonatal center between 2012 and 2023. Finally, 241 women were analyzed. An elevated sFlt-1/PlGF ratio at <34 weeks of gestation, but not at 34-36 or ≥37 weeks, was significantly associated with composite adverse maternal and fetal outcomes in women with suspected or confirmed PE/SPE. An sFlt-1/PlGF ratio of 400 was identified as the optimal cut-off level for predicting composite adverse maternal and fetal outcomes at <34 weeks. Among women with suspected or confirmed early-onset PE/SPE, HELLP syndrome alone was significantly associated with an sFlt-1/PlGF ratio ≥400. Additionally, the sFlt-1/PlGF ratio was significantly higher in women with HELLP syndrome, abnormal umbilical artery Doppler findings, or non-reassuring fetal status (NRFS) requiring immediate delivery, compared with those without these conditions. Furthermore, the interval from blood sampling to delivery significantly shortened with increasing sFlt-1/PlGF ratio. In conclusion, elevated sFlt-1/PlGF ratios were significantly associated with HELLP syndrome, abnormal umbilical artery Doppler findings, and NRFS requiring immediate delivery in women with suspected or confirmed early-onset PE/SPE. The sFlt-1/PlGF ratio at <34 weeks of gestation, but not at 34-36 or ≥37 weeks, was associated with composite adverse maternal and fetal outcomes in women with suspected or confirmed preeclampsia and super-imposed preeclampsia (PE/SPE). In women with suspected or confirmed early-onset PE/SPE, the sFlt-1/PlGF ratio was significantly higher not only in those with HELLP syndrome, but also in those with abnormal umbilical artery Doppler findings and non-reassuring fetal status (NRFS) requiring immediate delivery. Among women with suspected or confirmed early-onset PE/SPE, time to delivery from blood sampling decreased with increasing sFlt-1/PlGF ratio.
PMID:41115998 | DOI:10.1038/s41440-025-02428-0
