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SFlt-1/PlGF testing in a Canadian low resource setting: A prospective study evaluating implementation and

Shifana Lalani1, Katie Luiker1, Cameron Bruce1

  • 1Department of Obstetrics & Gynecology, Dalhousie University and IWK Health.

Journal of Obstetrics and Gynaecology Canada : JOGC = Journal D'Obstetrique Et Gynecologie Du Canada : JOGC
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Summary

Implementing soluble fms-like tyrosine kinase/placental growth factor (sFlt-1/PlGF) testing for preeclampsia did not reduce diagnosis time but identified earlier diagnoses and higher risks of adverse outcomes. This supports optimizing access to biochemical marker testing in regional centers.

Keywords:
Fetal Growth RetardationPlacentaPlacenta Growth FactorPre-eclampsiaPregnancy

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Area of Science:

  • Maternal-fetal medicine
  • Clinical biochemistry
  • Perinatal outcomes

Background:

  • Preeclampsia diagnosis and management are critical for maternal and fetal well-being.
  • Soluble fms-like tyrosine kinase (sFlt-1) and placental growth factor (PlGF) testing can aid in preeclampsia assessment.
  • Previous studies suggested sFlt-1/PlGF testing reduces time-to-diagnosis and identifies high-risk pregnancies.

Purpose of the Study:

  • To evaluate the impact of implementing sFlt-1/PlGF testing on preeclampsia diagnosis time.
  • To compare perinatal outcomes and estimated costs before and after sFlt-1/PlGF test implementation.
  • To assess the association of sFlt-1/PlGF testing with adverse fetal outcomes.

Main Methods:

  • Retrospective and prospective study design comparing singleton pregnancies with suspected preeclampsia before and after sFlt-1/PlGF implementation (2019-2023).
  • Inclusion criteria: gestational age 20-34 weeks and suspected preeclampsia or placental dysfunction.
  • Statistical analysis using negative binomial and Poisson regression with entropy balancing for confounding adjustment.

Main Results:

  • A total of 494 patients were identified before and 145 after sFlt-1/PlGF implementation.
  • Confirmed preeclampsia cases diagnosed after implementation had an earlier mean gestational age (31.8 vs. 33.1 weeks, P=0.001).
  • The post-implementation cohort showed a higher risk of neonatal intensive care unit (NICU) admission (RR 3.85) and all recorded fetal deaths (5.0%) were in patients with positive sFlt-1/PlGF results.

Conclusions:

  • sFlt-1/PlGF testing did not decrease the overall time-to-diagnosis for preeclampsia.
  • The testing was associated with earlier gestational age at diagnosis and identified increased risk for NICU admission and adverse fetal outcomes.
  • The findings support optimizing access to biochemical marker testing in regional centers for improved patient management.