224. Measurement of serum angiogenic markers at the 2nd trimester can predict fetal growth restriction (FGR) mothers who will subsequently develop preeclampsia (PE)

Objectives It is reported that FGR and PE are associated with abnormal profiles of angiogenic markers in maternal circulation. Mothers with FGR fetuses are at increased risks for developing PE. The aim of our study is to determine the cut-off levels of maternal serum angiogenic markers to develop PE subsequently among FGR mothers. Methods This study included women with singleton pregnancies diagnosed with FGR before 24 weeks of gestation (n = 50). The protocol was approved by ethics committees and participants provided written informed consents. The serum levels of PlGF, sFlt-1, sEndoglin and sFlt-1/PlGF ratio were measured at 20–24 weeks of gestation. The cut-off value of each angiogenic factor was determined by ROC curve analysis for identifying mothers with FGR at risk of developing PE. Results The prevalence of patients with FGR preceding PE was 40% (n = 20/50). The mean of onset period of subsequent PE was 30.1 ± 4.8 weeks of gestation. The mean gestational age at delivery of PE + FGR group and FGR only group was 32.4 ± 5.4 weeks vs 37.0 ± 4.9 weeks respectively. We compared serum levels of angiogenic factors among PE + FGR and FGR only groups. In the PE + FGR group, the level of PlGF was significantly decreased, and the levels of sFlt-1, sEndoglin, and sFlt-1/PlGF were significantly increased as compared with FGR only group. The optimal cut-off levels were PlGF level   1829.3 pg/mL (AUC = 0.884), sEndoglin level >7.41 ng/mL (AUC = 0.967), and sFlt-1/PlGF ratio >7.42(AUC = 0.941). sEndoglin and sFlt-1/PlGF ratio were the most powerful predictors for developing PEwith sensitivity of 88.9% and 86.7%, and specificity of 92.6 and 92.0% respectively. Conclusions Angiogenic factors measured in maternal sera between 20 and 24 weeks of gestation can identify mothers diagnosed with FGR who subsequently develop PE. Measurement of these markers may contribute to the risk assessment of mothers with FGR, and their clinical outcomes.