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Randomized Controlled Trial
. 2024 Jul;81(7):1561-1573.
doi: 10.1161/HYPERTENSIONAHA.123.22411. Epub 2024 May 6.

Repeat Placental Growth Factor-Based Testing in Women With Suspected Preterm Preeclampsia: A Stratified Analysis of the PARROT-2 Trial

Alice Hurrell  1 , Louise Webster  1 , Jenie Sparkes  1 , Cheryl Battersby  2 , Anna Brockbank  1 , Katherine Clark  1 , Kate E Duhig  3 , Carolyn Gill  1 , Marcus Green  4 , Rachael M Hunter  5 , Paul T Seed  1 , Zoe Vowles  1 , Jenny Myers  3 , Andrew H Shennan  1 , Lucy C Chappell  1 ; PARROT-2 Trial Group
Collaborators, Affiliations
Randomized Controlled Trial

Repeat Placental Growth Factor-Based Testing in Women With Suspected Preterm Preeclampsia: A Stratified Analysis of the PARROT-2 Trial

Alice Hurrell et al. Hypertension. 2024 Jul.

Abstract

Background: PlGF (placental growth factor)-based testing reduces severe maternal adverse outcomes. Repeat PlGF-based testing is not associated with improved perinatal or maternal outcomes. This planned secondary analysis aimed to determine whether there is a subgroup of women who benefit from repeat testing.

Methods: Pregnant individuals with suspected preterm preeclampsia were randomized to repeat revealed PlGF-based testing, compared with usual care where testing was concealed. Perinatal and maternal outcomes were stratified by trial group, by initial PlGF-based test result, and by PlGF-based test type (PlGF or sFlt-1 [soluble fms-like tyrosine kinase-1]/PlGF ratio).

Results: A total of 1252 pregnant individuals were included. Abnormal initial PlGF-based test identified a more severe phenotype of preeclampsia, at increased risk of adverse maternal and perinatal outcomes. Repeat testing was not significantly associated with clinical benefit in women with abnormal initial results. Of women with a normal initial result, 20% developed preeclampsia, with the majority at least 3 to 4 weeks after initial presentation. Repeat test results were more likely to change from normal to abnormal in symptomatic women (112/415; 27%) compared with asymptomatic women (163/890; 18%). A higher proportion of symptomatic women who changed from normal to abnormal were diagnosed with preeclampsia, compared with asymptomatic women.

Conclusions: Our results do not demonstrate evidence of the clinical benefit of repeating PlGF-based testing if the initial result is abnormal. Judicious use of repeat PlGF-based testing to stratify risk may be considered at least 2 weeks after a normal initial test result, particularly in women who have symptoms or signs of preeclampsia.

Registration: URL: https://www.isrctn.com/ISRCTN85912420; Unique identifier: ISRCTN85912420.

Keywords: biomarkers; blood pressure; hypertension; pre-eclampsia; pregnancy.

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Conflict of interest statement

Disclosures A.H. Shennan has received funds from Perkin Elmer (Revvity) and QuidelOrtho for expenses to meetings and has received money from Roche as a consultant on strategy. The other authors report no conflicts.

Figures

Figure.
Figure.
Longitudinal measurements of PlGF (placental growthfactor) and sFlt-1 (soluble fms-like tyrosine kinase-1)/PlGF across gestation. A, Median bands of longitudinal measurements of PlGF (pg/mL) across gestation, in women with at least 1 repeat test, stratified by initial test result, and final diagnosis of preeclampsia (PE; revealed and concealed groups). B, Median bands of longitudinal measurements of sFlt-1/PlGF across gestation, in women with at least 1 repeat test, stratified by initial test result, and final diagnosis of preeclampsia (revealed and concealed groups). SPE indicates superimposed pre-eclampisa.
See this image and copyright information in PMC

References

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