Placental Growth Factor informed management of suspected pre-eclampsia or fetal growth restriction: The MAPPLE cohort study

Sharp, Andrew ORCID: 0000-0003-3396-7464, Chappell, Lucy C, Dekker, Gustaaf, Pelletier, Sanja, Garnier, Yves, Zeren, Onur, Hillerer, Katharina M, Fischer, Thorsten, Seed, Paul T, Turner, Mark ORCID: 0000-0002-5299-8656
et al (show 2 more authors) (2018) Placental Growth Factor informed management of suspected pre-eclampsia or fetal growth restriction: The MAPPLE cohort study. PREGNANCY HYPERTENSION-AN INTERNATIONAL JOURNAL OF WOMENS CARDIOVASCULAR HEALTH, 14. pp. 228-233.

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<h4>Objectives</h4>Placental Growth Factor (PlGF) has been shown to be beneficial in diagnosing pre-eclampsia. We performed a prospective cohort study of revealed PlGF in standard clinical use in four teaching hospitals in UK, Germany, Austria and Australia.<h4>Study design</h4>Clinical data from women with suspected pre-eclampsia or fetal growth restriction <35 weeks' gestation with revealed PlGF measurement were collected (MAPPLE study).<h4>Main outcome measures</h4>Data were compared to the PELICAN study (PlGF concealed). Pre-specified outcomes were compared using standard statistical tests (median difference or Risk Ratio). The results were further categorised by PlGF concentration: i) very low (<12 pg/ml), ii) low (12-100 pg/ml), iii) normal (>100 pg/ml).<h4>Results</h4>396 women managed with revealed PlGF (MAPPLE) were compared with 287 women with concealed PlGF (PELICAN). Revealed PlGF led to delivery 1.4 weeks earlier (-2.0 to -0.9, 34.9 weeks vs 36.7 weeks). There were no significant differences in maternal adverse outcomes (11.9% vs 10.1%, Risk Ratio (RR) 1.17, 95% CI 0.76-1.82) or caesarean sections (73.8% vs 64.5%; RR 1.14, 95% CI 1.03-1.26). Revealed PlGF led to fewer perinatal deaths (2 vs 9; RR 0.16, 95% CI 0.03-0.74) and fewer babies with birthweight <3rd centile (28.9% vs 36.1%; RR 0.80, 0.65-0.99), but with more neonatal adverse outcomes (30.4% vs 17.1%; RR 1.78, 95% CI 1.32-2.41).<h4>Conclusions</h4>Revealed PlGF may be associated with lower perinatal mortality and birthweight <3rd centile but appears to lead to earlier delivery with more neonatal respiratory morbidity. Randomised trials with adequate power for clinical outcomes are needed.<h4>Funding</h4>Financial assistance was received from Alere to support the running of the MAPPLE database. Alere had no access to the information or control over the database itself.

Item Type: Article
Uncontrolled Keywords: Placental Growth Factor, Pre-eclampsia, Pregnancy outcome, Small for gestational age fetus, Stillbirth
Depositing User: Symplectic Admin
Date Deposited: 26 Mar 2018 06:12
Last Modified: 19 Jan 2023 06:37
DOI: 10.1016/j.preghy.2018.03.013
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