sFlt-1/PlGF Ratio in the Prediction of Preeclampsia in Pregnant Women With Diabetic Kidney Disease.

Abstract

Objectives: The objective of the study is to evaluate the potential role of the sFlt-1/PlGF ratio in predicting preeclampsia (PE) in pregnant women with diabetic kidney disease (DKD) during the second and third trimesters of pregnancy. Study Design: This study included 102 patients with DKD. All participants had a history of pregestational diabetes of at least 20 years' duration and/or onset before the age of 10 or pregestational diabetes complicated by hypertension or diabetic retinopathy (classified as D, R, or F according to White's classification). All patients exhibited elevated urinary protein loss (30-299 mg/24 h) or overt proteinuria (≥ 300 mg/24 h) during the first trimester of pregnancy. All participants were treated with intensive insulin therapy, either via multiple daily insulin injections (MDIs) or continuous subcutaneous insulin infusion (CSII). Serum levels of sFlt-1, PlGF, and the sFlt-1/PlGF ratio were assessed at both the 20th and 30th weeks of gestation. Main Outcome Measures: The serum levels of sFlt-1, PlGF, and the sFlt-1/PlGF ratio during the second and third trimesters were compared between women who developed PE and a control group without PE. Results: In DKD patients who developed PE, serum sFlt-1 levels were significantly higher, while PlGF levels were significantly lower, compared to those who did not develop PE. The sFlt-1/PlGF ratio was also markedly elevated in the PE group compared to controls during both the second and third trimesters. Increased sFlt-1 levels, decreased PlGF levels, and an elevated sFlt-1/PlGF ratio were significant predictors of PE development at both 20 and 30 weeks of gestation. The sFlt-1/PlGF ratio demonstrated a sensitivity of 72.7% and specificity of 75.7% at 20 weeks (sFlt-1/PlGF cut-off > 10.1) and a sensitivity of 84.6% and specificity of 82.0% at 30 weeks for predicting PE (sFlt-1/PlGF cut-off > 37). The positive predictive values were 47.1% and 50.0%, while the negative predictive values were 90.3% and 96.0% at 20 and 30 weeks, respectively. Conclusions: The assessment of antiangiogenic and proangiogenic markers, particularly the sFlt-1/PlGF ratio, appears to be a valuable tool for predicting PE in patients with long-lasting diabetes complicated by DKD.