Maternal Circulating sFlt-1:PlGF Ratio and Stillbirth

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Biomarkers in Pregnancy

Background:

• Stillbirth is a significant global health issue, disproportionately affecting low- and middle-income countries.
• Angiogenic imbalance, indicated by elevated sFlt-1 and reduced PlGF, is associated with placental dysfunction.
• The relationship between the sFlt-1:PlGF ratio and stillbirth risk requires further investigation.

Purpose of the Study:

• To examine the association between maternal serum sFlt-1:PlGF ratio and the risk of stillbirth.
• To utilize clinically relevant cutoffs for the sFlt-1:PlGF ratio in assessing stillbirth risk.

Main Methods:

• A case-control study was conducted in rural Bangladesh involving pregnant women.
• Maternal serum sFlt-1:PlGF ratio was measured, and stillbirth was the primary outcome.
• Firth penalized logistic regression was employed to analyze the association between sFlt-1:PlGF ratio cutoffs (>38 and >85) and stillbirth, with propensity score adjustment.

Main Results:

• An sFlt-1:PlGF ratio greater than 38 was significantly associated with increased odds of stillbirth (OR, 13.44).
• Similar findings were observed with an sFlt-1:PlGF ratio cutoff of 85 (OR, 12.95).
• High positive predictive values were noted for both cutoffs, while negative predictive values indicated a limited ability to rule out stillbirth.

Conclusions:

• Elevated maternal sFlt-1:PlGF ratios are strongly associated with stillbirth, suggesting a role for angiogenic imbalance.
• The sFlt-1:PlGF ratio may serve as a valuable predictive marker for stillbirth in resource-limited settings.
• These findings underscore the potential of angiogenic markers for identifying high-risk pregnancies and guiding interventions.