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Q&A

Hypertension

Poster Session 2

(587) Does sFlt1/PIGF predict superimposed preeclampsia in women with chronic hypertension during pregnancy? A meta-analysis

Tuesday, February 13, 2024

3:30 PM – 5:00 PM

Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

Primary & Presenting Author(s)

Audrey Scalia, BS

Medical Student
University of Arizona College of Medicine
Tucson, AZ, United States

Coauthor(s)

JW

Jessica Hao-Chen Wu, MD

OBGYN resident
Mount Sinai Hospital Chicago
Chicago, IL, United States
GS

Giovanni Sisti, MD

Fellow Physician
College of Medicine, University of Arizona
Tucson, AZ, United States

Objective: To identify the accuracy of the sFlt-1/PlGF ratio in predicting the occurrence of superimposed preeclampsia over chronic hypertension (CHTN).

Study Design: We identified clinical studies in Embase, PubMed, ClinicalTrials.gov, and Cochrane library assessing the efficacy of the sFlt-1/PlGF ratio in the maternal sera to predict the occurrence of superimposed preeclampsia over CHTN. Using the meta-analytic method, we generated a forest plot for standardized mean differences (SMDs) with their respective 95% confidence intervals (CIs). We performed a subgroup analysis according to the gestational age at blood collection: before 27 weeks of gestation, and after 27 weeks of gestation. If the patients had more than one blood collection during gestation, we considered them as different patients for the purpose of the analysis. A p value < 0.05 was considered statistically significant.

Results: Four articles were included in our final analysis. In two studies, the same patients had repeated blood collection during gestation. The total number of patients with CHTN was 775, of which 251 had superimposed preeclampsia and 524 did not. The gestational ages at blood collection in the four studies ranged from 12 to 30 weeks. Two studies had blood collected before 27 weeks of gestation, while four studies (the first two studies plus two others) had blood collected after 27 weeks of gestation. We found a statistically significant difference regarding the sFlt-1/PlGF ratio in CHTN patients at ≥ 27 weeks of gestation who later developed superimposed preeclampsia vs. those who did not (SMD of 0.43; CI of 0.17 - 0.69) (Figure 1). The quality in prognostic studies tool (QUIPS) and the funnel plot symmetry revealed an overall low risk of bias. The heterogeneity of the studies was high (I2 = 61%).

Conclusion: The sFlt-1/PlGF ratio was significantly associated with the development of superimposed preeclampsia in patients with CHTN when measured after 27 weeks of gestation, but not before. Our findings are limited by the high heterogeneity and the small number of included studies.