Martínez-Varea Alicia, Martínez-Sáez Clara, Domenech Josep, Desco-Blay Julia, Monfort-Pitarch Sagrario, Hueso María, Diago-Almela Vicente
Department of Obstetrics and Gynaecology, La Fe University and Polytechnic Hospital, Valencia, Spain.
Department of Economics and Social Sciences, Universitat Politècnica de València, Valencia, Spain.
Fetal Diagn Ther. 2022;49(4):206-214. doi: 10.1159/000525169. Epub 2022 May 24.
The objective was to elucidate if the sFlt-1/PlGF ratio at 24 weeks in twin pregnancies could be useful to select patients who subsequently develop diseases related to placental dysfunction, such as preeclampsia or fetal growth restriction (FGR).
This was a prospective study among all twin pregnancies followed up at a tertiary hospital. The sFlt-1/PlGF ratio was determined at 24 weeks.
A total of 108 patients with a twin gestation were included. Pregnant women who developed preeclampsia and/or FGR displayed a significantly higher sFlt-1/PlGF ratio at 24 weeks, compared to those who did not develop these diseases (20.3 vs. 4.3, p = 0.002). The mean sFlt-1/PlGF ratio was not significantly different between patients who subsequently developed preeclampsia compared with those that developed FGR (29.8 vs. 18.45, p = 0.42). A sFlt-1/PlGF ratio ≥17 at 24 weeks is associated with a significant increase in the frequency of preeclampsia (odds ratio, 37.13 [95% confidence interval, 4.78-288.25]; p = 0.002), and FGR (odds ratio, 39.58 [95% confidence interval, 6.31-248.17]; p < 0.001). The addition of maternal characteristics and mean pulsatility index of the uterine arteries to the sFlt-1/PlGF ratio at 24 weeks enhances the identification of patients who develop preeclampsia or FGR.
The sFlt-1/PlGF ratio at 24 weeks in twin pregnancies, combined with the mean pulsatility index of the uterine arteries and maternal characteristics, could select patients who develop preeclampsia or FGR. These patients might benefit from a close follow-up in order to avoid maternal-fetal adverse outcomes.
目的是阐明双胎妊娠24周时的可溶性血管内皮生长因子受体-1（sFlt-1）/胎盘生长因子（PlGF）比值是否有助于筛选出随后发生与胎盘功能障碍相关疾病的患者，如先兆子痫或胎儿生长受限（FGR）。
这是一项在一家三级医院对所有双胎妊娠进行随访的前瞻性研究。在24周时测定sFlt-1/PlGF比值。
共纳入108例双胎妊娠患者。发生先兆子痫和/或FGR的孕妇在24周时的sFlt-1/PlGF比值显著高于未发生这些疾病的孕妇（20.3对4.3，p = 0.002）。随后发生先兆子痫的患者与发生FGR的患者之间的平均sFlt-1/PlGF比值无显著差异（29.8对18.45，p = 0.42）。24周时sFlt-1/PlGF比值≥17与先兆子痫发生率显著增加相关（比值比，37.13 [95%置信区间，4.78 - 288.25]；p = 0.002），与FGR发生率显著增加相关（比值比，39.58 [95%置信区间，6.31 - 248.17]；p < 0.001）。将孕妇特征和子宫动脉平均搏动指数加入到24周时的sFlt-1/PlGF比值中，可提高对发生先兆子痫或FGR患者的识别能力。
双胎妊娠24周时的sFlt-1/PlGF比值，结合子宫动脉平均搏动指数和孕妇特征，可筛选出发生先兆子痫或FGR的患者。这些患者可能受益于密切随访，以避免母婴不良结局。
