In the JournalsPerspective

PARROT: Placental growth factor testing expedites preeclampsia diagnoses

Testing for placental growth factor in women with suspected preeclampsia reduced the time to clinical confirmation of the condition compared with usual care, according to a study published in The Lancet.

“For the last 100 years, we have diagnosed preeclampsia through measuring blood pressure and checking for protein in a woman’s urine,” Lucy C. Chappell, National Institute for Health Research Professor in Obstetrics at King’s College London, said in a press release. “These are relatively imprecise and often quite subjective. We knew that monitoring [placental growth factor] was an accurate way to help detect the condition but were unsure whether making this tool available to clinicians would lead to better care for women. Now we know that it does.”

Kate E. Duhig, research student in the department of women and children’s health at King’s College London, and colleagues analyzed data from 11 maternity units in the United Kingdom of women with suspected preeclampsia between 20 weeks and 36 weeks and 6 days of gestation. Blood samples were taken at inclusion into the study.

Women were either assigned the intervention (n = 573) or the control (n = 446). All 11 maternity units were randomly placed into blocks, which represented a time to start the intervention within 6-week intervals. All blocks initiated usual care to their patients at the start of the study. Once each successive block was initiated, a maternity unit would use the intervention and measure circulating placental growth factor.

The primary outcome was the time from trial entry to a diagnosis of preeclampsia, which was defined by the International Society for the Study of Hypertension in Pregnancy 2014 statement. The prespecified secondary maternal outcomes of interest were a composite of severe maternal adverse events, which included events such as maternal death, stroke, transient ischemic attack and MI. There were also prespecified secondary perinatal outcomes of interest such as gestation at delivery, late neonatal deaths and admission to a neonatal unit.

Testing for placental growth factor in women with suspected preeclampsia reduced the time to clinical confirmation of the condition compared with usual care, according to a study published in The Lancet.
Source: Adobe Stock

The median time to preeclampsia diagnosis was 1.9 days in the intervention group and 4.1 days in the control group (time ratio = 0.36; 95% CI, 0.15-0.87; P = .027).

Women in the intervention group had fewer severe maternal adverse outcomes vs. the control group (4% vs. 5%; adjusted OR = 0.32; 95% CI, 0.11-0.96). There was no difference in the composite adverse perinatal outcome in the intervention and control groups (15% vs. 14%, respectively; adjusted OR = 1.45; 95% CI, 0.73-2.9).

“[Placental growth factor] measurement could present a change for antenatal care that improves not only diagnosis, but also management and pregnancy outcome,” Duhig and colleagues wrote. – by Darlene Dobkowski

Disclosures: Duhig and Chappell report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

 

Testing for placental growth factor in women with suspected preeclampsia reduced the time to clinical confirmation of the condition compared with usual care, according to a study published in The Lancet.

“For the last 100 years, we have diagnosed preeclampsia through measuring blood pressure and checking for protein in a woman’s urine,” Lucy C. Chappell, National Institute for Health Research Professor in Obstetrics at King’s College London, said in a press release. “These are relatively imprecise and often quite subjective. We knew that monitoring [placental growth factor] was an accurate way to help detect the condition but were unsure whether making this tool available to clinicians would lead to better care for women. Now we know that it does.”

Kate E. Duhig, research student in the department of women and children’s health at King’s College London, and colleagues analyzed data from 11 maternity units in the United Kingdom of women with suspected preeclampsia between 20 weeks and 36 weeks and 6 days of gestation. Blood samples were taken at inclusion into the study.

Women were either assigned the intervention (n = 573) or the control (n = 446). All 11 maternity units were randomly placed into blocks, which represented a time to start the intervention within 6-week intervals. All blocks initiated usual care to their patients at the start of the study. Once each successive block was initiated, a maternity unit would use the intervention and measure circulating placental growth factor.

The primary outcome was the time from trial entry to a diagnosis of preeclampsia, which was defined by the International Society for the Study of Hypertension in Pregnancy 2014 statement. The prespecified secondary maternal outcomes of interest were a composite of severe maternal adverse events, which included events such as maternal death, stroke, transient ischemic attack and MI. There were also prespecified secondary perinatal outcomes of interest such as gestation at delivery, late neonatal deaths and admission to a neonatal unit.

Testing for placental growth factor in women with suspected preeclampsia reduced the time to clinical confirmation of the condition compared with usual care, according to a study published in The Lancet.
Source: Adobe Stock

The median time to preeclampsia diagnosis was 1.9 days in the intervention group and 4.1 days in the control group (time ratio = 0.36; 95% CI, 0.15-0.87; P = .027).

Women in the intervention group had fewer severe maternal adverse outcomes vs. the control group (4% vs. 5%; adjusted OR = 0.32; 95% CI, 0.11-0.96). There was no difference in the composite adverse perinatal outcome in the intervention and control groups (15% vs. 14%, respectively; adjusted OR = 1.45; 95% CI, 0.73-2.9).

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“[Placental growth factor] measurement could present a change for antenatal care that improves not only diagnosis, but also management and pregnancy outcome,” Duhig and colleagues wrote. – by Darlene Dobkowski

Disclosures: Duhig and Chappell report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

 

    Perspective
    Ki Park

    Ki Park

    Preeclampsia is a significant cause of maternal and neonatal morbidity and mortality during pregnancy. However, early diagnostic testing has been lacking. This study found that use of an angiogenic factor, placental growth factor, when studied in real-world practice, reduced the time to diagnosis of preeclampsia, leading to reduced maternal adverse outcomes

    The findings of this study are potentially relevant for everyday practice, as early diagnosis did lead to reduced adverse maternal outcomes, as the average time to diagnosis was reduced by several days.

    The findings of this study did not note a reduction in perinatal adverse outcomes or gestational age at delivery. However, once placental growth factor results were released, the trial did not dictate any changes in care management, leaving decisions regarding delivery timing to the discretion of the treating physician. Further studies may expand on the results presented here to aim in guiding management of patients diagnosed earlier with preeclampsia.

    • Ki Park, MD
    • Interventional Cardiologist
      Clinical Assistant Professor of Medicine
      University of Florida, Gainesville
      Cardiology Today Next Gen Innovator

    Disclosures: Park reports no relevant financial disclosures.