Evaluating trajectories of placental growth factor (PlGF) and pregnancy outcomes following multimodal screening for preeclampsia

Objective. Multimodal screening with placental growth factor (PlGF) between 11-14 weeks’ gestation is a better predictor of preeclampsia than clinical history alone. PlGF also accurately predicts preeclampsia up to 36 weeks’ gestation. The objec­tive of this study was to evaluate PlGF levels after multimodal screening to determine if different PlGF trajectories are associ­ated with adverse pregnancy outcomes.
Materials and Methods. We linked data from a single centre first trimester multimodal preeclampsia screening and aspirin prophylaxis study between 30 October 2019 and 10 June 2021 with data from a parallel study evaluating PlGF during the second/third trimester. We used mixed effects models to ex­amine different PlGF trajectories and time-to-event regression models to evaluate associations with pregnancy outcomes, in­cluding preterm birth and preeclampsia. We assessed effects of aspirin on PlGF trajectories and pregnancy outcomes.
Results. Of 1,057 patients enrolled in multimodal preeclamp­sia screening, 411 had additional PlGF testing in the second/ third trimester. Repeat testing was associated with a high-risk screen result, previous preeclampsia, assisted reproductive technology, and older age. High-risk patients had lower PlGF levels at subsequent tests (β = -98.2 pg/mL; 95%CI -134.4 to -62.1; p < 0.01) and were more likely to deliver preterm (HR = 3.20; 95%CI 1.90-5.39; p < 0.01). Different trajectory patterns of PlGF were seen between groups, and PlGF was positively associated with gestational age at delivery.
Conclusions. Multimodal preeclampsia screening outcomes at 11-14 weeks’ gestation are associated with distinct PlGF tra­jectories in the second/third trimester and clinical outcomes. These findings suggest PlGF trajectories can aid the prediction of adverse pregnancy outcomes.
John Snelgrove, John Kingdom, and Kelsey McLaughlin re­ceived research funding supporting this project from the Roche Diagnostics Grant Program. Nanette Okun received re­search funding supporting this project from the Mount Sinai/ University Health Network AMO Innovation Fund.