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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
|June 23, 2026
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.
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.
