Predictive Value for Preeclampsia of sFlt-1:PlGF Ratio in Pregnancy Complicated by Gestational Diabetes

BACKGROUND AND AIMS: Gestational diabetes (GDM) and preeclampsia (PE) are major complications of pregnancy. The ratio of soluble Fms-like tyrosine kinase 1 to placental growth factor (sFlt-1/PlGF) may predict the short-term absence of PE in pregnant women with clinically suspected PE. The aim of this study was to determine the role of placental angiogenic factors in predicting PE risk in women with pregnancies complicated by GDM. MATERIALS AND METHODS: In this prospective observational study, pregnant women were enrolled at the time of screening for GDM. sFlt-1 and PlGF were measured at 24-28, 28-32 and 35-37 weeks of gestation. Univariate and multivariate analysis were used to investigate risk factors for PE. RESULTS: Of 398 women, 213 (53.5%) had GDM and 18 (5%) developed PE (67% with GDM). GDM women developing PE had significantly lower levels of PlGF at 24-28, 28-32 and 35-37 gestational weeks, and higher sFlt1 and sFlt1/PlGF at 28-32 and 35-37 gestational weeks compared with GDM women without PE. On a multivariate analysis, PlGF and sFlt1/PlGF were associated with PE, regardless of other clinical data. A sFlt1/PlGF ratio > 38 at 28-32 gestational weeks identified GDM women at risk of developing PE within the ensuing 4 weeks, with 100% sensitivity and good specificity. CONCLUSION: In women with GDM, the sFlt1/PlGF ratio can identify those at higher risk of PE. TRIAL REGISTRATION: NCT04877119: 2021-04-29.