Angiogenic Biomarkers and Neonatal Outcomes in Suspected Preeclampsia: Retrospective Cohort Study

Placental growth factor (PlGF) and soluble fms-like tyrosine kinase 1 (sFlt1) are two biomarkers associated with placental function and the sFlt-1/PlGF ratio is frequently used for risk assessment and prediction of preeclampsia in pregnancy. OBJECTIVE: To assess the association between elevated sFlt-1/PlGF ratio and adverse neonatal outcomes in pregnancies with suspected preeclampsia. DESIGN: Retrospective cohort study. SETTING: A tertiary centre in Hong Kong. POPULATION: 162 singleton neonates delivered between January 2020 and May 2023 from pregnancies complicated by suspected preeclampsia and sFlt-1/PlGF taken within 4 weeks before delivery. METHODS: Pregnant women with suspected preeclampsia were recruited with analysis of serum Flt-1 and PlGF. Neonatal outcomes were compared between neonates from pregnancies with sFlt-1/PlGF ratio ≥ 85 (high-risk group) and < 85 (low-risk group). MAIN OUTCOME MEASURES: Neonatal outcomes including growth, respiratory, gastrointestinal, and metabolic complications. RESULTS: Logistic regression analysis showed that after adjustment for gestational age, preeclampsia and newborn sex, sFlt-1/PlGF ratio ≥ 85 was significantly associated with small-for-gestation (SGA; aOR = 2.52, 95% C.I. = 1.12-5.60), feeding intolerance (aOR = 3.03, 95% C.I. = 1.01-9.09), need for parenteral nutrition (PN; aOR = 11.19, 95% C.I. = 2.23-56.29), prolonged PN (aOR = 6.92, 95% C.I. = 1.43-33.39), hospitalisation over 7 and 30 days (aOR = 3.62, 95% C.I. = 1.20-10.87 and aOR = 7.04, 95% C.I. = 1.08-45.80 respectively). Linear regression showed a significant association between sFlt-1/PlGF ratio and duration of respiratory support, PN and duration of hospital stay. CONCLUSIONS: An elevated maternal sFlt-1/PlGF ratio within 4 weeks of delivery is significantly associated with adverse neonatal outcomes including SGA, gastrointestinal complications, prolonged parenteral nutrition and prolonged hospitalisation.