Wiebke Schaarschmidt1, Sarosh Rana, Holger Stepan. 1. Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. wiebke.schaarschmidt@medizin.uni-leipzig.de
Abstract
AIMS: Preeclampsia (PE) is considered a uniformly progressive disease, however, it shows a different pattern of clinical progression in patients with early (<34 weeks) or late (≥ 34 weeks) onset of the disease. Angiogenic factors such as soluble fms-like tyrosine kinase 1 (sFlt-1) and placental growth factor (PlGF) are closely related to the clinical course of PE. We evaluated sFlt-1 and PlGF levels in the clinical course of PE in women admitted with a diagnosis of PE at different gestational ages. METHODS: This retrospective study included 34 patients with PE, of which 11 patients had HELLP syndrome (over a period of 3 years). Serial measurements of sFlt-1 and PlGF were completed from admission until delivery. Values are presented as mean ± standard deviation. RESULTS: Mean gestational age of admission among women with early onset PE was significantly lower, at 29 ± 3 weeks compared to 37±1 weeks among patients with late onset disease. Mean prolongation of pregnancy was 6 days, which was similar within the two groups. Compared to women with late onset PE, women with early-onset PE had a greater increase in sFlt-1 (11% vs. 3% per day, P<0.05), greater decrease in PlGF levels (21% vs. 10% per day, P=0.30), resulting in a much higher increase in sFlt-1/PlGF ratio (23% vs. 8% per day, P<0.05). Patients with HELLP syndrome showed comparable progression patterns. CONCLUSION: In a similar way to the progressively worsening clinical course observed in women with early onset PE, there were changes in the angiogenic profile that leads to a more anti-angiogenic state in these women with each passing day. These findings may have implications in identification of the women for appropriate patient management and possible future therapies based on the reduction of sFlt-1 levels.
AIMS: Preeclampsia (PE) is considered a uniformly progressive disease, however, it shows a different pattern of clinical progression in patients with early (<34 weeks) or late (≥ 34 weeks) onset of the disease. Angiogenic factors such as soluble fms-like tyrosine kinase 1 (sFlt-1) and placental growth factor (PlGF) are closely related to the clinical course of PE. We evaluated sFlt-1 and PlGF levels in the clinical course of PE in women admitted with a diagnosis of PE at different gestational ages. METHODS: This retrospective study included 34 patients with PE, of which 11 patients had HELLP syndrome (over a period of 3 years). Serial measurements of sFlt-1 and PlGF were completed from admission until delivery. Values are presented as mean ± standard deviation. RESULTS: Mean gestational age of admission among women with early onset PE was significantly lower, at 29 ± 3 weeks compared to 37±1 weeks among patients with late onset disease. Mean prolongation of pregnancy was 6 days, which was similar within the two groups. Compared to women with late onset PE, women with early-onset PE had a greater increase in sFlt-1 (11% vs. 3% per day, P<0.05), greater decrease in PlGF levels (21% vs. 10% per day, P=0.30), resulting in a much higher increase in sFlt-1/PlGF ratio (23% vs. 8% per day, P<0.05). Patients with HELLP syndrome showed comparable progression patterns. CONCLUSION: In a similar way to the progressively worsening clinical course observed in women with early onset PE, there were changes in the angiogenic profile that leads to a more anti-angiogenic state in these women with each passing day. These findings may have implications in identification of the women for appropriate patient management and possible future therapies based on the reduction of sFlt-1 levels.
Authors: Stefan Verlohren; Ignacio Herraiz; Olav Lapaire; Dietmar Schlembach; Manfred Moertl; Harald Zeisler; Pavel Calda; Wolfgang Holzgreve; Alberto Galindo; Theresa Engels; Barbara Denk; Holger Stepan Journal: Am J Obstet Gynecol Date: 2011-07-30 Impact factor: 8.661
Authors: Ravi Thadhani; Tuelay Kisner; Henning Hagmann; Verena Bossung; Stefanie Noack; Wiebke Schaarschmidt; Alexander Jank; Angela Kribs; Oliver A Cornely; Claudia Kreyssig; Linda Hemphill; Alan C Rigby; Santosh Khedkar; Tom H Lindner; Peter Mallmann; Holger Stepan; S Ananth Karumanchi; Thomas Benzing Journal: Circulation Date: 2011-08-01 Impact factor: 29.690
Authors: Stefan Verlohren; Alberto Galindo; Dietmar Schlembach; Harald Zeisler; Ignacio Herraiz; Manfred G Moertl; Juliane Pape; Joachim W Dudenhausen; Barbara Denk; Holger Stepan Journal: Am J Obstet Gynecol Date: 2009-10-21 Impact factor: 8.661
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Authors: Sang Jin Kim; Alexander D Port; Ryan Swan; J Peter Campbell; R V Paul Chan; Michael F Chiang Journal: Surv Ophthalmol Date: 2018-04-19 Impact factor: 6.048
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Authors: H Stepan; I Herraiz; D Schlembach; S Verlohren; S Brennecke; F Chantraine; E Klein; O Lapaire; E Llurba; A Ramoni; M Vatish; D Wertaschnigg; A Galindo Journal: Ultrasound Obstet Gynecol Date: 2015-03 Impact factor: 7.299
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