The role of angiogenic and antiangiogenic factors in the stratification of preeclampsia risk in high- and low-risk pregnant women according to the results of extended prenatal screening

Оbjective: to evaluate the effectiveness of using MAPP-A and PlGF in the first trimester of pregnancy and the rate of increase in angiogenic imbalance (sFlt-1/PLGF) in the second to third trimesters for early and accurate stratification of highrisk pregnant women for the development of preeclampsia.

Materials and methods: the prospective study included 69 pregnant women divided into two groups: group 1, with a high risk of preeclampsia, n=37, and group 2, with a low risk of preeclampsia, n=32. The levels of angiogenesis biomarkers: PlGF and sFlt-1 were determined in dynamics, at gestation periods of 20, 24, 28, 32 weeks.

Results: in group 1, at 12 weeks, the levels of RARP-A (1.55 ± 2.0 iU/l) and PlGF (27.34 ± 25.80 iU/l) were lower than in women from group 2, RARP-A (3.23 ± 2.34 iU/L, p<0.001) and PlGF (43.21 ± 14.58 iU/l, p=0.012), respectively.  The sFlt-1/PlGF study showed an increase in the 1st group at 24 weeks - 31.2 ± 49 iU/l compared with the 2nd group - 3.7 ± 1.8 iU/l (p=0.002). The concentration of sFlt-1 in the high-risk group increased from the 20th to the 32nd week, reaching 6369.4 ± 5078 pg/ml (p=0.030). Preeclampsia developed in 45.9% of women in group 1, as opposed to 15.6% of women in group 2 (p=0.003), odds ratio 0.217 (95% CI: 0.077–0.609).

Conclusion: assessment of the level of PAPP-A and PlGF in the first trimester and the dynamics of sFlt-1/PlGF at 20, 24, 28, and 32 weeks allows stratification of the risk of preeclampsia in high-risk pregnant women by preeclampsia. The revealed dynamics of angiogenic imbalance, significant differences were obtained from the 24th week, is 8-12 weeks ahead of the clinical manifestation.

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