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

Abstract

The soluble Fms-like tyrosine kinase-1/placental growth factor (sFlt-1/PlGF) ratio blood test can aid the prediction of preeclampsia (PE) in advance of a clinical diagnosis. Gestational diabetes mellitus (GDM) predisposes to PE, but may influence levels of these biomarkers independently of PE. To determine whether the sFlt-1/PlGF ratio retains its clinical utility to predict PE in patients with GDM. Retrospective analysis of sFlt-1/PlGF ratio and associated clinical outcome data acquired between September 2016 and September 2022, at the Royal Women's Hospital, Melbourne, Australia. 1416 sFlt-1/PlGF ratio results from pregnant women with and without GDM, and with and without PE were analysed. The main outcome measures were sFlt-1, PlGF and sFlt-1/PlGF ratio test results in relation to PE and GDM. There were no significant differences in the area under the curve (AUC), specificity, sensitivity, positive predictive value, or negative predictive value (NPV) between the PE + No GDM and PE + GDM groups in both the 0 to 7 and the 8 to 14 days before delivery categories. In the 0- to 7-day category the PE + No GDM group had an AUC of 0.82 (95% CI 0.79-0.87), sensitivity of 85.3% (95% CI 80.8-89.1%) and NPV of 92.7% (95% CI 90.5-94.5%), and the PE + GDM group had an AUC of 0.87 (95% CI 0.82-0.93), sensitivity of 89.4% (95% CI 76.9-96.5%), and NPV of 94.8% (95% CI 88.7-97.7%). The results of this investigation indicate that although GDM may lead to changes in the sFlt-1/PlGF ratio, the sFlt-1/PlGF ratio test retains its clinical utility in predicting PE onset.