Clinical outcomes following implementation of diagnostic testing for pre-eclampsia within a UK tertiary hospital setting using angiogenic biomarkers

Objective

To evaluate real-world implementation of angiogenic biomarkers (sFLT1:PlGF, Roche Elecsys®) to enhance the diagnosis of pre-eclampsia within a UK tertiary maternity centre.

Study design

Retrospective cohort study.

Main outcome measures

Perinatal outcomes were collated from routine pregnancy data and compared before and after the introduction of sFLT1:PlGF ratio testing. For those women receiving a test (September 2019 to Feb 2021), the diagnosis of pre-eclampsia and adverse events were recorded.

Results

From routinely recorded data, there was a trend towards a rise in the proportion of births 34–37 weeks (4.8 % vs 5.4 %; p = 0.054) after test implementation, crude perinatal mortality rates were not different. Detailed outcomes were available for 660 pregnancies following sFLT1/PlGF testing of whom 30.7 % developed pre-eclampsia, 153 (23.2 %) required birth before 37 weeks. 99 % of the pregnancies complicated by a sFLT:PlGF ratio ≥ 85 had a clinical diagnosis of pre-eclampsia, 6/13 false negative tests (ratio < 38) were in twin pregnancies. Higher sFLT:PlGF ratios or lower PlGF values correlated with preterm birth and lower birth weight percentiles, while higher sFLT levels were associated with a reduced test to birth interval.

Conclusions

Introduction of sFLT:PlGF ratio testing for suspected pre-eclampsia demonstrated very high diagnostic accuracy but was not associated with a measurable difference in perinatal outcomes within the maternity population. sFLT:PlGF testing identified a sub-group of women with ratio values ≥ 85 that were more likely to require high-dependency care, however absolute levels of either sFLT-1 or PlGF were not strongly associated with clinical features of maternal or perinatal disease severity.