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First-Trimester Placental Growth Factor and HELLP Syndrome: The PREDICTION Study.
Emmanuel Bujold1, Kypros H Nicolaides2, Nan Okun3
1Department of Gynecology, Obstetrics and Reproduction, Université Laval, Québec, QC; Reproduction, Mother and Child Health Unit, CHU De Québec - Université Laval Research Center, Université Laval, Québec, QC.
Journal of Obstetrics and Gynaecology Canada : JOGC = Journal D'Obstetrique Et Gynecologie Du Canada : JOGC
|May 10, 2026
Summary
First-trimester placental growth factor (PlGF) levels were associated with HELLP syndrome risk. Low PlGF was the only identified early predictor for HELLP syndrome in nulliparous women.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Perinatal Research
Background:
- Hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome is a severe complication of preeclampsia.
- Early identification of HELLP syndrome risk is crucial for improved maternal and fetal outcomes.
Purpose of the Study:
- To investigate the association between first-trimester placental growth factor (PlGF) and other established preeclampsia risk factors with the development of HELLP syndrome.
- To determine if early pregnancy markers can predict HELLP syndrome in nulliparous women.
Main Methods:
- Secondary analysis of a prospective cohort of 7325 nulliparous women.
- Stratification into HELLP syndrome, preeclampsia without HELLP, and control groups.
- Comparison of first-trimester maternal age, BMI, MAP, UtA-PI, and serum PlGF (MoM) using non-parametric and ROC analyses.
Main Results:
- Median PlGF was significantly lower in both preeclampsia and HELLP syndrome groups compared to controls.
- Low PlGF (≤0.7 MoM) showed prediction rates of 56% for preterm and 33% for term HELLP syndrome.
- Unlike preeclampsia without HELLP, HELLP syndrome showed no association with first-trimester BMI, MAP, or UtA-PI.
Conclusions:
- First-trimester low placental growth factor (PlGF) is the sole identified factor associated with HELLP syndrome.
- PlGF measurement in early pregnancy may serve as a valuable screening tool for HELLP syndrome risk.
