Predicting Preeclampsia in Gestational Diabetes Mellitus Using the sFlt-1/PlGF Ratio

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Clinical Biochemistry

Background:

• The sFlt-1/PlGF ratio is a validated biomarker for predicting preeclampsia (PE).
• Gestational diabetes mellitus (GDM) is a known risk factor for PE and may independently affect sFlt-1/PlGF levels.
• The predictive utility of the sFlt-1/PlGF ratio in the presence of GDM requires further investigation.

Purpose of the Study:

• To evaluate the diagnostic performance of the sFlt-1/PlGF ratio for preeclampsia prediction in pregnant women with and without GDM.
• To determine if GDM influences the clinical utility of the sFlt-1/PlGF ratio test for PE prediction.

Main Methods:

• Retrospective analysis of 1,416 sFlt-1/PlGF ratio results and clinical outcomes.
• Data collected from September 2016 to September 2022 at The Royal Women's Hospital, Melbourne.
• Comparison of predictive performance (AUC, sensitivity, specificity, PPV, NPV) between PE patients with and without GDM.

Main Results:

• No significant differences in predictive performance (AUC, specificity, sensitivity, PPV, NPV) were observed between PE groups with and without GDM.
• In the 0-7 day prediction window, the sFlt-1/PlGF ratio demonstrated high accuracy (AUC 0.82-0.87) and negative predictive value (NPV 92.7%-94.8%) in both groups.
• The sFlt-1/PlGF ratio maintained its predictive capability for PE onset, irrespective of GDM status.

Conclusions:

• The sFlt-1/PlGF ratio test retains its clinical utility for predicting preeclampsia onset.
• Despite potential GDM-induced alterations in biomarker levels, the test's predictive power for PE remains robust.
• This finding supports the continued use of the sFlt-1/PlGF ratio in managing pregnant women with or at risk for GDM and PE.