First-trimester maternal serum levels of placenta growth factor as predictor of preeclampsia and fetal growth restriction

OBJECTIVE: To determine whether the reported decrease in maternal serum pla centa growth factor concentration in preeclampsia is evident from the first trimester and before clinical onset of the disease. We also examined level s in pregnancies that subsequently resulted in fetal growth restriction (FG R). METHODS: Placenta growth factor concentration was measured in stored matern al serum samples obtained at 11-14 weeks of gestation from 131 women who su bsequently developed preeclampsia, 137 women who subsequently developed FGR , and 400 randomly selected controls who did not develop preeclampsia or FG R. Preeclampsia was defined as diastolic blood pressure of 90 mmHg or more on two occasions 4 hours apart, accompanied by proteinuria (more than 300 m g of total protein in a 24-hour urine collection or a positive test for alb umin on reagent strip) in women with no pre-existing hypertensive or renal disease. Fetal growth restriction was considered present if a woman subsequ ently delivered a live infant with a birth weight below the fifth centile f or gestation. RESULTS: In the control group, maternal serum placenta growth factor concen tration increased with gestation. Compared with the controls (median multip le of the median 0.98, standard deviation [SD] 0.51), levels in the preecla mpsia group (median multiple of the median 1.09, SD 0.52) were not signific antly different (t = 1.83, P = .07), but in the FGR group (median multiple of the median 1.57, SD 0.74), levels were significantly increased (t = 10.8 5, P < .001). CONCLUSION: The previously reported decrease in serum placenta growth facto r levels in women with preeclampsia might not precede clinical onset of the disease and is not apparent in the first trimester of pregnancy. Levels ar e significantly increased in pregnancies resulting in FGR. (C) 2001 by the American College of Obstetricians and Gynecologists.