Repeat Placental Growth Factor-Based Testing in Women With Suspected Preterm Preeclampsia: A Stratified Analysis of the PARROT-2 Trial
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Published:2024-05-06
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ISSN:0194-911X
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Container-title:Hypertension
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language:en
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Short-container-title:Hypertension
Author:
Hurrell Alice1ORCID, Webster Louise1, Sparkes Jenie1ORCID, Battersby Cheryl2ORCID, Brockbank Anna1ORCID, Clark Katherine1ORCID, Duhig Kate E.3ORCID, Gill Carolyn1ORCID, Green Marcus4ORCID, Hunter Rachael M.5ORCID, Seed Paul T.1ORCID, Vowles Zoe1ORCID, Myers Jenny3ORCID, Shennan Andrew H.1ORCID, Chappell Lucy C.1ORCID, Gill Carolyn, McDonnell Sian, Peers Beth, Yulia Angela, Ferry Orla, Maher Martin, Pickering Francis, Smith Annabel, Thompson Hilary, Basak Sambita, Dudgeon Lucy, Ficquet Jo, Rich Mel, O’Brien Clare, Willson Seren, Chados Nikolaos, Bishop Linda, Bahl Rachna, Smart Brittany, Arya Rita, Roughley Lindsay, Mehta Anku, Campbell Deniesha, Girling Jo, Ryan Grace, Trepte Lauren, Biswas Chandrima, Obiozo Chinwe, Verghese Lynda, Ahuja Ashwin, Davies Sarah, Morris Katie, Davison Jessica, Regan Maeve, Myers Jenny, Barry Natalie, McBean Mel, Jennings Jacqui, Sharp Andrew, Holt Siobhan, Stirrat Laura, Jack Elaine, Bapir Mihraban, Gowans Sharon, Alexander Hazel, Hinshaw Kim, Hewitt Lesley
Affiliation:
1. Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, United Kingdom (A.H., L.W., J.S., A.B., C.G., P.T.S., K.C., Z.V., A.H.S., L.C.C.). 2. Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London Chelsea and Westminster Hospital Campus, United Kingdom (C.B.). 3. Division of Developmental Biology and Medicine, Maternal and Fetal Health Research Centre, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, United Kingdom (K.E.D., J.M.). 4. Action on Pre-Eclampsia, Evesham, United Kingdom (M.G.). 5. Institute of Epidemiology and Health Care, University College London, United Kingdom (R.M.H.).
Abstract
BACKGROUND:
PlGF (placental growth factor)-based testing reduces severe maternal adverse outcomes. Repeat PlGF-based testing is not associated with improved perinatal or maternal outcomes. This planned secondary analysis aimed to determine whether there is a subgroup of women who benefit from repeat testing.
METHODS:
Pregnant individuals with suspected preterm preeclampsia were randomized to repeat revealed PlGF-based testing, compared with usual care where testing was concealed. Perinatal and maternal outcomes were stratified by trial group, by initial PlGF-based test result, and by PlGF-based test type (PlGF or sFlt-1 [soluble fms-like tyrosine kinase-1]/PlGF ratio).
RESULTS:
A total of 1252 pregnant individuals were included. Abnormal initial PlGF-based test identified a more severe phenotype of preeclampsia, at increased risk of adverse maternal and perinatal outcomes. Repeat testing was not significantly associated with clinical benefit in women with abnormal initial results.
Of women with a normal initial result, 20% developed preeclampsia, with the majority at least 3 to 4 weeks after initial presentation. Repeat test results were more likely to change from normal to abnormal in symptomatic women (112/415; 27%) compared with asymptomatic women (163/890; 18%). A higher proportion of symptomatic women who changed from normal to abnormal were diagnosed with preeclampsia, compared with asymptomatic women.
CONCLUSIONS:
Our results do not demonstrate evidence of the clinical benefit of repeating PlGF-based testing if the initial result is abnormal. Judicious use of repeat PlGF-based testing to stratify risk may be considered at least 2 weeks after a normal initial test result, particularly in women who have symptoms or signs of preeclampsia.
REGISTRATION:
URL: XXX; Unique identifier: ISRCTN85912420.
Publisher
Ovid Technologies (Wolters Kluwer Health)
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