OBSTETRICS The sFlt-1/PlGF ratio in different types of hypertensive pregnancy disorders and its prognostic potential in preeclamptic patients Stefan Verlohren, MD; Ignacio Herraiz, MD; Olav Lapaire, MD; Dietmar Schlembach, MD; Manfred Moertl, MD; Harald Zeisler, MD; Pavel Calda, MD; Wolfgang Holzgreve, MD; Alberto Galindo, MD; Theresa Engels, MD; Barbara Denk, PhD; Holger Stepan, MD OBJECTIVE: The soluble fms-like tyrosine kinase (sFlt-1)/placental growth factor (PlGF) ratio is a reliable tool in the assessment of pre- eclampsia. We tested the hypothesis that the sFlt-1/PlGF ratio is able to identify women at risk for imminent delivery. We characterized the sFlt- 1/PlGF ratio in different types of hypertensive pregnancy disorders. STUDY DESIGN: We investigated 388 singleton pregnancies with nor- mal pregnancy outcome, 164 with PE, 36 with gestational hyperten- sion, and 42 with chronic hypertension. sFlt-1 and PlGF were measured in serum samples. RESULTS: Patients with preeclampsia had a significantly increased sFlt-1/PlGF ratio as compared with controls and with patients with chronic and gestational hypertension in 34 weeks and 34 weeks (P  .001). Time to delivery was significantly reduced in women with preeclampsia in the highest quartile of the sFlt-1/PlGF ratio (P  .001). CONCLUSION: The sFlt-1/PlGF ratio allows the identification of women at risk for imminent delivery and is a reliable tool to discriminate be- tween different types of pregnancy-related hypertensive disorders. Key words: gestational hypertension, placental growth factor, PIGF, preeclampsia, singleton pregnancy, soluble fms-like tyrosine kinase, sFlt-1 Cite this article as: Verlohren S, Herraiz I, Lapaire O, et al. The sFlt-1/PlGF ratio in different types of hypertensive pregnancy disorders and its prognostic potential in preeclamptic patients. Am J Obstet Gynecol 2011;205:xx-xx. P reeclampsia (PE), a multisystem dis- order in pregnancy, is still a leading cause of maternal and fetal morbidity and mortality. 1 Occurring with an incidence of 2-8% worldwide, PE represents one of the major contributors of preterm birth, ac- counting for 15% of all preterm deliver- ies. 2,3 PE is defined as the new onset of hypertension (140/90 mm Hg) and pro- teinuria (300 mg per 24 hours) after 20 weeks of gestation. 4 Other hypertensive disorders in preg- nancy comprise gestational hypertension (GH) and chronic hypertension (chrHTN). 4 However, these definitions do not take into account the clinical variety of the disease as well as its impact on mother and child. Moreover, the current clas- sification does not consider the fact that the speed of the clinical disease progression can vary dramatically be- tween patients with different subtypes of PE. 5 Recently several modifications of this simple definition of a complex disease have tried to cope with the clinical diver- sity of the maternal syndrome. 6-9 Actual definition proposals try to implement early-onset PE as a severity criterion as well as include a definition of severe hy- pertension apart from mild hyperten- sion. It is known that the perinatal risk and the maternal complications are the greater, the earlier PE occurs. However, the late preterm birth also carries an in- creased risk of perinatal morbidity, and maternal complications are also de- scribed in late PE. 10 The reliable identification of high-risk PE patients is crucial because intensified monitoring and referral to specialized perinatal care centers substantially re- duce maternal and fetal morbidity. 11,12 From the Department of Obstetrics, Campus Virchow-Clinic, Charité University Medicine Berlin (Drs Verlohren and Engels); Institute for Advanced Study (Dr Holzgreve), Berlin; Clinical Operations Professional Diagnostics, Roche Diagnostics, Penzberg (Dr Denk); and Department of Obstetrics, University Hospital Leipzig, Leipzig (Dr Stepan), Germany Department of Obstetrics and Gynecology, University Hospital 12 de Octubre, Madrid, Spain (Drs Herraiz and Galindo); Department of Obstetrics and Gynecology, University of Basel, Basel, Switzerland (Dr Lapaire); Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (Drs Schlembach and Moertl); Department of Obstetrics and Gynecology, University of Vienna Medical School, Vienna, Austria (Dr Zeisler); and Department of Obstetrics and Gynecology, Charles University, Prague, Czech Republic (Dr Calda). Received Jan. 9, 2011; revised June 1, 2011; accepted July 25, 2011. B.D. is employed by Roche Diagnostics, Penzberg, Germany. H.S. has received consultancy payments from Roche regarding advice on clinical trial design. S.V. and H.S. received lecture fees from Roche. None of the other authors reports a conflict of interest. Reprints: Stefan Verlohren, MD, Department of Obstetrics, Charité University Medicine, Augustenburger Platz 1, D-13353 Berlin, Germany. stefan.verlohren@charite.de. 0002-9378/$36.00 • © 2011 Mosby, Inc. All rights reserved. • doi: 10.1016/j.ajog.2011.07.037 Research www. AJOG.org MONTH 2011 American Journal of Obstetrics & Gynecology 1.e1