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. 2010 Sep 28:10:58.
doi: 10.1186/1471-2393-10-58.

Periodic assessment of plasma sFlt-1 and PlGF concentrations and its association with placental morphometry in gestational hypertension (GH) - a prospective follow-up study

Kamalan Jeevaratnam  1 , Vishna Devi Nadarajah, John Paul Judson, Sivalingam Nalliah, Mohd Farouk Abdullah
Affiliations

Periodic assessment of plasma sFlt-1 and PlGF concentrations and its association with placental morphometry in gestational hypertension (GH) - a prospective follow-up study

Kamalan Jeevaratnam et al. BMC Pregnancy Childbirth. .

Abstract

Background: Hypertensive disorders in pregnancy contributes to about 12% of maternal deaths in Malaysia and similarly worldwide. Early detection and adequate management are preventable strategies. Biochemical markers of abnormal angiogenesis would be more specific in early detection than routine blood pressure and proteinuria measurements. The aim of this study was to estimate maternal plasma PlGF and sFlt-1 levels in pregnant women with gestational hypertension at three intervals of pregnancy and correlate these biomarker levels with placental morphometry.

Methods: Venous blood samples (antepartum, intrapartum and post partum periods) were drawn to estimate for sFlt-1 and PlGF levels while placental tissue samples were examined for placental morphometry.

Results: PlGF levels were lower in gestational hypertension (GH) compared to normotensive during antepartum and intrapartum period, whereas sFlt-1 levels were elevated in GH at antepartum, intrapartum and postpartum intervals during pregnancy. An inverse relationship between these two biomarkers was observed through correlation analysis. PlGF levels were inversely correlated with total villous surface area of the placental periphery (TCsa-C) and villous capillarization (VC-C) of the placental periphery.

Conclusion: We established periodic values of for sFlt-1 and PlGF levels for the first time in an ethnically diverse Malaysian setting. We suggest the development of GH in women is related to defective capillarization. In demonstrating periodic changes, this study suggest the possibility of developing GH and other long term health complications as a result of prolonged exposure to sFlt-1. The correlation between PlGF levels and morphometric findings also support possible capillarization defect.

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Figures

Figure 1
Figure 1
Morphometric calculation for villous capillarization (VC) and intervillous space (IvS) of placental villi. Calculation of VC was done by dividing the surface area of the capillary (blue outline) over the surface area of the villous (black outline). Calculation of IvS was done by subtracting the surface area of the photomicrograph (calculated by height {H} X width {W}; green outline indicated by black arrows) with the summed up area of all villous (black outline) within a particular photomicrograph. The surface area (mm2) of the respective capillaries and villous measured was generated by the software program. This slide was viewed at 20× magnification.
Figure 2
Figure 2
Baseline levels of plasma PlGF in women based on period of sampling. Baseline levels of plasma PlGF were determined using ELISA. Values displayed are mean ± standard error (SE) of the three intervals (antepartum, intrapartum and postpartum), obtained from normotensive and GH women. Means with similar superscript differ significantly at P < 0.05.
Figure 3
Figure 3
Baseline levels of plasma sFlt-1 in women based on period of sampling. Baseline levels of plasma sFlt-1 were determined using ELISA. Values displayed are mean ± standard error (SE) of the three intervals (antepartum, intrapartum and postpartum), obtained from normotensive and GH women. Means with similar superscript differ significantly at P < 0.05.
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