Cited by 668Pregnancy and preeclampsia studiesNeurological Complications and SyndromesNeonatal and fetal brain pathology

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Angiogenic Factors and the Risk of Adverse Outcomes in Women With Suspected Preeclampsia

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Rana, Sarosh, Powe, Camille E., Salahuddin, Saira, Verlohren, Stefan, Perschel, Frank H., Levine, Richard J., Lim, Kee-Hak, Wenger, Julia B., Thadhani, Ravi, Karumanchi, S. Ananth·2012·Circulation

DOI 10.1161/circulationaha.111.054361PMC PMC3319742

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Abstract

BACKGROUND: An imbalance in circulating angiogenic factors plays a central role in the pathogenesis of preeclampsia. METHODS AND RESULTS: We prospectively studied 616 women who were evaluated for suspected preeclampsia. We measured plasma levels of antiangiogenic soluble fms-like tyrosine kinase 1 (sFlt1) and proangiogenic placental growth factor (PlGF) at presentation and examined for an association between the sFlt1/PlGF ratio and subsequent adverse maternal and perinatal outcomes within 2 weeks. The median sFlt1/PlGF ratio at presentation was elevated in participants who experienced any adverse outcome compared with those who did not (47.0 [25th-75th percentile, 15.5-112.2] versus 10.8 [25th-75th percentile, 4.1-28.6]; P<0.0001). Among those presenting at <34 weeks (n=167), the results were more striking (226.6 [25th-75th percentile, 50.4-547.3] versus 4.5 [25th-75th percentile, 2.0-13.5]; P<0.0001), and the risk was markedly elevated when the highest sFlt1/PlGF ratio tertile was compared with the lowest (odds ratio, 47.8; 95% confidence interval, 14.6-156.6). Among participants presenting at <34 weeks, the addition of sFlt1/PlGF ratio to hypertension and proteinuria significantly improved the prediction for subsequent adverse outcomes (area under the curve, 0.93 for hypertension, proteinuria, and sFlt1/PlGF versus 0.84 for hypertension and proteinuria alone; P=0.001). Delivery occurred within 2 weeks of presentation in 86.0% of women with an sFlt1/PlGF ratio ≥85 compared with 15.8% of women with an sFlt1/PlGF ratio <85 (hazard ratio, 15.2; 95% confidence interval, 8.0-28.7). CONCLUSIONS: In women with suspected preeclampsia presenting at <34 weeks, circulating sFlt1/PlGF ratio predicts adverse outcomes occurring within 2 weeks. The accuracy of this test is substantially better than that of current approaches and may be useful in risk stratification and management. Additional studies are warranted to validate these findings.

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Circulating angiogenic factors and the risk of preeclampsia
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Angiogenesis biomarkers for the prediction of severe adverse outcomes in late-preterm preeclampsia
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Influential
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“Patients were classified into three groups according to the results of the sFlt-1/PlGF ratio, using the cutoff points that have been determined by previous studies [12,20]: first, no angiogenic imbalance, sFlt-1/PlGF ratio of 38 or less; second, mild angiogenic imbalance, sFlt-1/PlGF ratio of more than 38 to less than…”
MethodResult
Biomarker of Early Glomerular Injury in Pre-eclampsia
Kandasamy, Y., Watson, D., & Rudd, D. (2015) · Hypertension in Pregnancy · doi:10.3109/10641955.2015.1065883 · Cited by 8
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Background
Early pregnancy angiogenic proteins levels and pregnancy related hypertensive disorders
Jakovljević, A., Bogavac, M. A., Lozanov-Crvenković, Z., Milosević-Tosic, M., Nikolic, A., & Mitic, G. P. (2016) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.1080/14767058.2016.1177814 · Cited by 8
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Background
Second-trimester urine nephrin:creatinine ratio versus soluble fms-like tyrosine kinase-1:placental growth factor ratio for prediction of preeclampsia among asymptomatic women
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Retracted
Effects of perinatal blood pressure on maternal brain functional connectivity
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Karumanchi, S. A., Rana, S., & Taylor, R. N. (2014) · Elsevier eBooks · doi:10.1016/b978-0-12-407866-6.00006-7 · Cited by 7
Point‐of‐Care Tests for Preeclampsia: Systematic Review and Meta‐Analysis of Diagnostic Test Accuracy Studies
Elbarbary, N., Pritsini, F., Kazi, A., Wang, C., Thilaganathan, B., & Bhide, A. (2024) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/1471-0528.18040 · Cited by 7
Placental Biomarker Testing for Evaluation of Suspected Preeclampsia
Silasi, M., Azzi, M., Potchileev, S., Burns, L. P., & Rana, S. (2025) · Clinical Chemistry · doi:10.1093/clinchem/hvaf024 · Cited by 7
One-third of patients with eclampsia at term do not have an abnormal angiogenic profile
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Utility of sFtl-1 and Placental Growth Factor Ratio for Adequate Preeclampsia Management
Ciciu, E., Paṣatu‐Cornea, A.-M., Dumitru, S., Petcu, L. C., Salim, C., & Tuta, L. A. (2023) · Healthcare · doi:10.3390/healthcare11030381 · Cited by 7
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Satorres-Pérez, E., Martínez‐Varea, A., Álamo, B. N.-D., Morales‐Roselló, J., & Diago, V. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13061784 · Cited by 7
Multicentre randomised trial of screening with sFlt1/PlGF and planned delivery to prevent pre-eclampsia at term: protocol of the PE37 study
Llurba, E., Crispi, F., Crovetto, F., Youssef, L., Delgado⋈, J. L., Puig, I., Móra, J., Krofta, L., Macková, K., Martínez‐Varea, A., et al. (2024) · BMJ Open · doi:10.1136/bmjopen-2023-076201 · Cited by 7
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“However, their study included only 21 women [33].”
BackgroundInfluential
Angiogenic factors and prediction for ischemic placental disease in future pregnancies
Johnson, K. M., Smith, L., Modest, A. M., Salahuddin, S., Karumanchi, S. A., Rana, S., & Young, B. C. (2021) · Pregnancy Hypertension · doi:10.1016/j.preghy.2021.05.011 · Cited by 7
Use of the angiogenic biomarker profile to risk stratify patients with fetal growth restriction
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Relevance of maternal sodium level for preeclampsia-associated adverse pregnancy outcomes
Dröge, L. A., Eidmann, J., Aigner, A., Frank, L., Perschel, F. H., Henrich, W., & Verlohren, S. (2021) · Pregnancy Hypertension · doi:10.1016/j.preghy.2021.05.021 · Cited by 7
The clinical value of PlGF and the sFlt1/PlGF ratio in the management of hypertensive pregnancy disorders: A retrospective real-world study in China
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CD158a+/CD158b+ NK cell imbalance correlates with hypertension in patients with pre‐eclampsia
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Melo, D. M. D. D. E., de Sousa, R. P. B., Pais, M., Felix, L. M., Pinto, F. F., & Moura, J. P. S. (2023) · Journal of Perinatal Medicine · doi:10.1515/jpm-2022-0353 · Cited by 7
The need to redefine preeclampsia
Espinoza, J. (2012) · Expert Opinion on Medical Diagnostics · doi:10.1517/17530059.2012.691093 · Cited by 7
“More recently, a large prospective study demonstrated that among women with the suspicion of preeclampsia at less than 34 weeks, a sFlt-1/PlGF ‡ 85 identified 86% of women who delivered within 2 weeks of presentation [125].”
Background
Expression of placental growth factor mRNA in preeclampsia
Nikuei, P., Rajaei, M., Malekzadeh, K., Nejatizadeh, A., Mohseni, F., Pourdarvishi, F., Ghashghaeezadeh, N., & Mohtarami, M. (2017) · International Journal of Reproductive BioMedicine (IJRM) · doi:10.29252/ijrm.15.3.169 · Cited by 7
“VEGF and PlGF, which are associated with adequate vascular endothelial homeostasis, are antagonized by sFlt-1 (17).”
Background
Precision Diagnostics by Affinity-Mass Spectrometry: A Novel Approach for Fetal Growth Restriction Screening during Pregnancy
Okai, C. A., Ruß, M., Wölter, M., Andresen, K., Rath, W. H., Glocker, M. O., & Pecks, U. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9051374 · Cited by 7
“acyl-CoA dehydrogenase deficiency” [22,32,33], but also with sFlt-1/PlGF ratio (<38 and >85) [34,35] and PlGF measurements alone to predict still-birth FGR (<12 and >100) [36].”
BackgroundInfluential
Preeclampsia for the Nephrologist: Current Understanding in Diagnosis, Management, and Long-term Outcomes
Bajpai, D. (2020) · Advances in Chronic Kidney Disease · doi:10.1053/j.ackd.2020.05.001 · Cited by 7
Predictive value of biochemical marker ADAM-12 at first trimester of pregnancy for hypertension and intrauterine growth restriction
Kasimis, C., Evangelinakis, N. E., Rotas, M., Georgitsi, M., Pelekanos, N., & Kassanos, D. (2016) · Clinical and Experimental Obstetrics & Gynecology · doi:10.12891/ceog2000.2016 · Cited by 7
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“assessment in women with chronic hypertension.(14) Whether”
Angiogenic Proteins
Rana, S., & Sannon, H. (2017) · Hypertension · doi:10.1161/hypertensionaha.116.08641 · Cited by 7
“In an earlier cohort study that analyzed the use of these biomarkers in third trimester patients presenting with suspected preeclampsia, we showed that high soluble fms-like tyrosine kinase/PlGF ratio predicted delivery within 2 weeks.(7) More recently, Chappell et al(8) also reported that low PlGF alone in patients w…”
Prenatal Low-Dose Aspirin Use Associated with Reduced Incidence of Postpartum Hypertension among Women with Preeclampsia
Christenson, E., Stout, M. J., Williams, D., Verma, A., Dávila‐Román, V. G., & Lindley, K. J. (2021) · American Journal of Perinatology · doi:10.1055/s-0041-1728826 · Cited by 6
sFlT-1/PlGF ratio as a predictor of preeclampsia in COVID-19 pregnant patients
Pluta, K., Januszewski, M., Ziuzia-Januszewska, L., Kudan, M., Suchocka, M., Kuśmierczuk, K., Issat, T., & Jakimiuk, A. J. (2024) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-024-06263-y · Cited by 6
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Background
Angiogenic Biomarkers in Preeclampsia
Burwick, R. M., & Rodriguez, M. H. (2024) · Obstetric Anesthesia Digest · doi:10.1097/01.aoa.0001026496.50416.ee · Cited by 6
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Zielińska, J., & Darmochwał-Kolarz, D. (2025) · Medical Science Monitor · doi:10.12659/msm.945628 · Cited by 7
“Therefore, it seems justified to perform an assessment of the sFlt-1 to PlGF ratio in the third trimester of pregnancy in women at high risk for preeclampsia to minimize adverse perinatal events for those who develop preeclampsia, by determining the appropriate time and place for delivery [54].”
Preeclampsia: Contemporary Concepts in Pathophysiology, Risk Stratification, Prevention and Monitoring
Witkowski, P., Dzieński, B., Stefańska, K., Tomaszewicz, M., Zabielska-Kaczorowska, M. A., & Wydra, D. G. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15051944 · Cited by 6
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“have shown that the sFlt-1/PlGF ratio is able to predict preeclampsia-associated adverse outcomes with a high degree of accuracy.(14) Several predictors such as abnormalities of the flow of the umbilical artery detected via Doppler ultrasound and ductus venosus have been reported in placental insufficiency that could…”
Background
Decreased PPP1R3G in pre-eclampsia impairs human trophoblast invasion and migration via Akt/MMP-9 signaling pathway
Shi, H., Kong, R., Xu, M., Gou, L., Yin, X., Ding, Y., Cao, X., Meng, Q., Gu, M., & Suo, F. (2023) · Experimental Biology and Medicine · doi:10.1177/15353702231182214 · Cited by 6
Screening tests for preeclampsia: in search of clinical utility
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Is Canada Ready to Adopt Maternal Placental Growth Factor Testing to Improve Clinical Outcomes for Women with Suspected Preeclampsia?
Walker, M. G., Bujold, E., & Kingdom, J. C. (2017) · Journal of Obstetrics and Gynaecology Canada · doi:10.1016/j.jogc.2016.10.013 · Cited by 6
Correlation between placental weight and angiogenic markers sFlt-1 and PlGF in women with preeclampsia and fetal growth restriction
Lorenz-Meyer, L. A., Frank, L., Sroka, D., Busjahn, A., Henrich, W., & Verlohren, S. (2022) · Pregnancy Hypertension · doi:10.1016/j.preghy.2022.04.002 · Cited by 6
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Amabebe, E., Ikumi, N. M., Pillay, K., Matjila, M. J., & Anumba, D. O. C. (2023) · Placenta and Reproductive Medicine · doi:10.54844/prm.2023.0361 · Cited by 6
Longitudinal changes of angiogenic factors as a potential predictive tool in women with suspected preeclampsia
Montenegro-Martínez, J., Carrasco, A. C., Núñez-Jurado, D., Beltrán, L. M., & Fatela‐Cantillo, D. (2024) · Pregnancy Hypertension · doi:10.1016/j.preghy.2024.01.130 · Cited by 6
Maternal fish consumption, fatty acid levels and angiogenic factors: The Generation R Study
Bautista‐Niño, P. K., Tielemans, M. J., Schalekamp–Timmermans, S., Graaff, J. S., Albert Hofman, D., Tiemeier, H. W., Jaddoe, V. W. V., Steegers, E. A. P., Felix, J. F., & Franco, O. H. (2015) · Placenta · doi:10.1016/j.placenta.2015.07.125 · Cited by 6
Predictive value of soluble fms‐like tyrosine kinase‐1 against placental growth factor for preeclampsia in a Chinese pregnant women population
Fan, Y., Bai, Q., Zhang, S., & Jiang, Y. (2019) · Journal of Clinical Laboratory Analysis · doi:10.1002/jcla.22861 · Cited by 6
Placental growth factor blunts uterine artery responses to angiotensin II
Espinoza, J., Betancourt, A., Belfort, M., Shamshirsaz, A., Fox, K., & Yallampalli, C. (2019) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/1471-0528.15656 · Cited by 6
Risk Factor and Biomarker of Preeclampsia
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Angiogenesis Markers and Recovery From Acute Kidney Injury: A Piece of the Puzzle?
Bouchard, J., & Mehta, R. L. (2019) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2019.03.421 · Cited by 6
The interval between births and the risk of recurrent preeclampsia among predominantly high risk women in urban tertiary care center
Njoroge, S., Kuriloff, M., Mueller, A., Perdigao, J. L., Dhir, R., & Rana, S. (2021) · Pregnancy Hypertension · doi:10.1016/j.preghy.2021.05.009 · Cited by 9
Intensive care patients with preeclampsia – Clinical risk factors and biomarkers for oxidative stress and angiogenic imbalance as discriminators for severe disease
Edvinsson, C., Hansson, E., Nielsen, N., Erlandsson, L., & Hansson, S. R. (2022) · Pregnancy Hypertension · doi:10.1016/j.preghy.2022.08.005 · Cited by 6
Ratio between fms-like Tyrosine Kinase 1 and Placental Growth Factor in Children with Congenital Heart Disease
Sugimoto, M., Oka, H., Kajihama, A., Nakau, K., Kuwata, S., Kurishima, C., & Azuma, H. (2014) · Pediatric Cardiology · doi:10.1007/s00246-014-1054-8 · Cited by 6
“a combination biomarker that further enhances the predictive capacity of the individual biomarkers [23, 26].”
Background
Low Serum Levels of HtrA3 at 15 Weeks of Gestation Are Associated with Late-Onset Preeclampsia Development and Small for Gestational Age Birth
Teoh, S. S. Y., Wang, Y., Li, Y., Leemaqz, S., Dekker, G., Roberts, C. T., & Nie, G. (2019) · Fetal Diagnosis and Therapy · doi:10.1159/000497144 · Cited by 6
Biomarkers in Preeclampsia
Karumanchi, S. A. (2016) · Elsevier eBooks · doi:10.1016/b978-0-12-803014-1.00014-5 · Cited by 6
Short-Term Prediction of Preeclampsia: How Close Are We?
Chappell, L. C., Bramham, K., & Shennan, A. H. (2014) · Biomarkers in Medicine · doi:10.2217/bmm.14.22 · Cited by 6
Longitudinal 8-Epi-Prostaglandin F2-Alpha and Angiogenic Profile Mediator Evaluation during Pregnancy in Women with Suspected or Confirmed Pre-eclampsia
Dijmărescu, A. L., Tanase, F., Novac, M. B., Siminel, M. A., Rotaru, I., Caragea, D. C., Manolea, M. M., Văduva, C.-C., Boldeanu, M. V., & Boldeanu, L. (2024) · Biomedicines · doi:10.3390/biomedicines12020433 · Cited by 5
Risk for Imminent Delivery in Preeclampsia Based on the sFlt-1/PlGF Ratio: Do We Need New Cut-Offs?
Enengl, S., Oppelt, P., Stelzl, P., Scharnreitner, I., Altmann, R., Grienberger, J., Hermann, P., Wagner, H., Rezk, M., Damian, I., et al. (2025) · Geburtshilfe und Frauenheilkunde · doi:10.1055/a-2497-8104 · Cited by 5
A point-of-care urine test to predict adverse maternal and neonatal outcomes in Asian women with suspected preeclampsia
Wong, N. K. L., Wah, Y. M. I., Wong, S. T., Nguyen‐Hoang, L., Lau, C. S. L., Ip, P. N. P., Leung, H. H. Y., Sahota, D. S., & Poon, L. C. (2023) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-023-07257-5 · Cited by 5
“Previous studies accounted only for severe adverse outcomes such as PE with severe complications or bio-chemical derangements or extreme preterm delivery before 34 weeks [7, 23, 24].”
Influential
A prospective cohort study on the prediction of the diagnosis-to-delivery time in preeclamptic pregnancies: should the sFlt-1/PlGF ratio be added to routine evaluations?
Köse, S., Tuna, G., NURİYEVA, G., Altunyurt, S., İşlekel, H., & Doğan, E. (2018) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-018-4903-5 · Cited by 5
Circulating soluble fms-like tyrosine kinase-1, soluble endoglin and placental growth factor during pregnancy in normotensive women in KwaZulu-Natal, South Africa
Ogunlola, M. O., Reddy, P., Sibiya, M. N., O’Connor, L., Borg, D., Haffejee, F., Ghuman, S., Ngxongo, T. S. P., & Govender, N. (2019) · African Health Sciences · doi:10.4314/ahs.v19i2.4 · Cited by 5
Predictive possibility of the transverse cerebellar diameter to abdominal circumference ratio for small-for-gestational-age fetus suspected as a cause of maternal placental syndromes: a retrospective cohort study
Shinohara, S., Okuda, Y., Hirata, S., & Suzuki, K. (2020) · Hypertension in Pregnancy · doi:10.1080/10641955.2020.1747487 · Cited by 5
“abruption; and maternal/fetal death, might be confounded (5,8,9).”
Background
Fetal programming effects of pentaerythritol tetranitrate in a rat model of superimposed preeclampsia
Man, A. W. C., Chen, M., Zhou, Y., Wu, Z., Reifenberg, G., Daiber, A., Münzel, T. F., Xia, N., & Li, H. (2020) · Journal of Molecular Medicine · doi:10.1007/s00109-020-01949-0 · Cited by 5
“diseases and dementia later in life [4].”
Expert consensus: Indication criteria and screening strategy for preeclampsia using the serum sFlt-1/PlGF ratio at 18–36 weeks of gestation in women at imminent/basal risk of preeclampsia under insurance coverage
Ohkuchi, A., Kondoh, E., Yamamoto, T., Seki, H., Saito, S., Makino, S., Nishida, M., & Kikuchi, T. (2020) · Hypertension Research in Pregnancy · doi:10.14390/jsshp.hrp2020-009 · Cited by 6
Association of fetal sex with angiogenic factors in normotensive and hypertensive pregnancy states
Arenas, G. A., Docheva, N., Perdigao, J. L., Mueller, A., Dada, T., & Rana, S. (2022) · Pregnancy Hypertension · doi:10.1016/j.preghy.2022.07.003 · Cited by 5
Biochemical Dysregulation of Pre-Eclampsia and Gestational Diabetes Mellitus
Portelli, M., & Baron, B. (2019) · IntechOpen eBooks · doi:10.5772/intechopen.85843 · Cited by 6
Imaging of Neurologic Disorders in Pregnancy
Jamieson, D. G., & McVige, J. W. (2019) · Neurologic Clinics · doi:10.1016/j.ncl.2019.09.001 · Cited by 5
Impact of Aging and Cellular Senescence in the Pathophysiology of Preeclampsia
Suvakov, S. R., Kattah, A. G., Gojković, T., Enninga, E. A. L., Pruett, J. E., Jayachandran, M., Sousa, C., Santos, J., Hassan, C. A., Suarez, M. L. G., et al. (2023) · Comprehensive physiology · doi:10.1002/cphy.c230003 · Cited by 6
“The absolute levels and ratio of sFlt-1 to PlGF do not have the same discriminatory ability in later onset ( > 34 weeks onset) preeclampsia (388).”
Prospective Study Evaluating the Association Between sFlt-1/PlGF Ratio and Adverse Outcomes in Preterm Preeclampsia
Ghesquière, L., Bujold, E., Djedid, Y., Masmoudi, A., Magherbi, H. E., Feirouz, A., & Chelli, D. (2025) · Journal of Obstetrics and Gynaecology Canada · doi:10.1016/j.jogc.2025.102963 · Cited by 4
Serum soluble-fms-like tyrosine kinase 1-to-placental growth factor ratio on Elecsys immunoassay platform predicts preeclampsia with severe features in hospitalized women with hypertensive disorders of pregnancy
Berg, A. H., Calsavara, V. F., Hund, M., Ge, G., Rana, S., Costantine, M. M., Espinoza, J., Boggess, K., Wylie, B. J., Simas, T. A. M., et al. (2025) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2025.11.006 · Cited by 4
Internal and external validation of a machine learning algorithm to detect preeclampsia-related adverse outcomes in high-risk pregnancies
Hackelöer, M., Rieger, O., Suresh, S. C., Mueller, A., Hoyler, A., Schmidt, L., Neznansky, M., Lorenz-Meyer, L. A., Henrich, W., Rana, S., et al. (2026) · Pregnancy Hypertension · doi:10.1016/j.preghy.2026.101457 · Cited by 4
The association between serum soluble fms-like tyrosine kinase-1, placental growth factor, and soluble fms-like tyrosine kinase-1/placental growth factor ratio in singleton pregnancy and placental abruption: a systematic review and meta-analysis
Kosińska–Kaczyńska, K., Szymusik, I., Brawura-Biskupski-Samaha, R., & Sys, D. (2025) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2025.04.020 · Cited by 4
Explainable machine learning reveals ribosome biogenesis biomarkers in preeclampsia risk prediction
Chen, J., Zhang, D., Zhu, C., Lin, L., Ye, K., Hua, Y., & Peng, M. (2025) · Frontiers in Immunology · doi:10.3389/fimmu.2025.1595222 · Cited by 4
Predicting Time to Delivery in Hypertensive Disorders: Assessing PlGF and sFlt-1 with the Novel Parameter ‘Mtp-Multiples of a Normal Term Placenta’
Giardini, V., Santagati, A., Marelli, E., Casati, M., Cantarutti, A., & Vergani, P. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13071899 · Cited by 4
“Rana and colleagues found that delivery occurred within 2 weeks in 86.0% of women with an sFlt-1/PlGF ratio > 85 before 34 weeks’ gestation [22].”
BackgroundInfluential
Predicting Preeclampsia Pregnancy Termination Time Using sFlt-1
Tanaka, H., Tanaka, K., Takakura, S., Enomoto, N., & Ikeda, T. (2022) · Frontiers in Medicine · doi:10.3389/fmed.2022.900639 · Cited by 4
Evolutionary perspective of uteroplacental malperfusion: subjacent insult common to most pregnancy complications
Espinoza, J. (2023) · Ultrasound in Obstetrics and Gynecology · doi:10.1002/uog.26218 · Cited by 4
Distinguishing preeclampsia using the falling scaled slope (FSS) --- a novel photoplethysmographic morphological parameter
Chen, H., Jiang, F., Chen, W., Feng, Y., Chen, S., Miao, J., Jiao, C., & Chen, X. (2023) · Hypertension in Pregnancy · doi:10.1080/10641955.2023.2225617 · Cited by 4
“Specifically, PE could have a series of impacts on both patient and infant, resulting in maternal cerebrovascular, cardiac, hepatic, hematologic, and renal complications, sometimes even prematurity and neonatal mortality (2,6).”
Background
The importance of angiogenic markers in the differential diagnosis of HELLP syndrome vs. non-HELLP thrombocytopenia
Quirós, C., Suárez, F., García, B. P., Rodríguez, V., Ruiz, Ó. V., & Menéndez, F. V. Á. (2015) · Clinical Chemistry and Laboratory Medicine (CCLM) · doi:10.1515/cclm-2015-0890 · Cited by 4
Real-World Use of Biomarkers in Management of Hypertension During Pregnancy
Suresh, S. C., & Rana, S. (2021) · Hypertension · doi:10.1161/hypertensionaha.120.16422 · Cited by 4
Maternal Microvascular Dysfunction During and After Preeclamptic Pregnancy
Schwartz, K., & Stanhewicz, A. E. (2024) · Comprehensive physiology · doi:10.1002/cphy.c240003 · Cited by 11
Abnormale Plazentation: Hypertensive Schwangerschaftserkrankungen
Schlembach, D., Baumann, M., Kehl, S., Klaritsch, P., & Lobmaier, S. M. (2024) · Springer Reference Medizin · doi:10.1007/978-3-662-63506-3_18 · Cited by 4
Increasing incidence of hypertensive disorders of pregnancy and association with decreased GFR and albuminuria: The need for post-partum follow-up
Gracia-Iguacel, C., Toran, M. P., Navidad, M. Á., Pérez, B. G., Arce-Obieta, J. M., Morocho-Pindo, C., González‐Parra, E., Mahíllo, I., & Ortíz, A. (2025) · Placenta · doi:10.1016/j.placenta.2025.03.017 · Cited by 4
Predictors of adverse pregnancy outcomes in severe preeclampsia: A retrospective observational study
Li, P., Jiang, Y., & You, Y. (2025) · Medicine · doi:10.1097/md.0000000000042258 · Cited by 4
“[47] Including gestational age and cholesterol extends this approach, providing a more comprehensive assessment by integrating clinical and biochemical data.”
Predictive value of Glycosylated Fibronectin (GlyFn)/Placenta Growth Factor (PlGF) ratio for high-risk pregnancies: a cohort study
Wirawan, W., Krisnadi, S. R., Anwar, A. D., & Nugrahani, A. D. (2025) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-025-07853-0 · Cited by 3
“Glycosylated Fibronectin (GlyFn), a complex formed by plasma and cellular Fn [13, 14] has shown strong correlations with endothelial dysfunction and vascular remodeling disorders associated with PE [10–17].”
Maternal and neonatal outcomes in pregnancies with sFlt-1/PlGF >85: exploring the predictive value of sFlt-1 and PlGF
Hubble, T. R., Nzelu, D., Kastora, S. L., Hillman, S. L., Williams, D. J., & Stott, D. (2025) · Pregnancy Hypertension · doi:10.1016/j.preghy.2025.101266 · Cited by 3
Elevated sFlt-1/PlGF ratio in women with suspected or confirmed early-onset preeclampsia and super-imposed preeclampsia complicated by HELLP syndrome as well as abnormal umbilical artery Doppler findings and non-reassuring fetal status requiring immediate delivery: a prospective cohort study
Ohkuchi, A., Suzuki, H., Hirashima, C., Takahashi, K., Ogoyama, M., Horie, K., Usui, R., Takahashi, H., Fujiwara, H., & Yamamoto, T. (2025) · Hypertension Research · doi:10.1038/s41440-025-02428-0 · Cited by 3
“In addition, among the cited studies, ﬁ ve evaluated suspected and con-ﬁ rmed PE/SPE simultaneously [4, 11, 13, 18, 20], although majority studies evaluated only con ﬁ rmed PE/SPE [5 – 7, 14, 16, 17, 19, 22 – 24].”
Influential
The sFlt-1/PlGF-ratio and the risk of preeclampsia-related adverse outcomes in subsequent pregnancies with signs and symptoms of a preeclampsia
Lorenz-Meyer, L. A., Thoma, J., Scherfeld, V., Sroka, D., Aigner, A., Henrich, W., & Verlohren, S. (2024) · Pregnancy Hypertension · doi:10.1016/j.preghy.2024.101140 · Cited by 3
Clinical outcomes following implementation of diagnostic testing for pre-eclampsia within a UK tertiary hospital setting using angiogenic biomarkers
Gibson, M., Tomlinson, E., Barry, N., Kouvatsou, A., Kingdom, J. C., Johnstone, E., & Myers, J. (2025) · Pregnancy Hypertension · doi:10.1016/j.preghy.2025.101227 · Cited by 3
Rosiglitazone as a potential therapeutic drug in early intervention of preeclampsia
Liu, F., Zhang, X., Fournier, T., Degrelle, S. A., Zitouni, H., Yang, J., & Luo, F. (2025) · Pregnancy Hypertension · doi:10.1016/j.preghy.2025.101233 · Cited by 3
ANGIOGENIC IMBALANCES IN THE PATHOGENESIS OF PREGNANCY COMPLICATIONS
Espinoza, J. (2014) · Fetal and Maternal Medicine Review · doi:10.1017/s0965539514000096 · Cited by 3
What’s New in Obstetric Anesthesia? The 2013 Gerard W. Ostheimer Lecture
Palanisamy, A. (2014) · Anesthesia & Analgesia · doi:10.1213/ane.0000000000000101 · Cited by 3
Biomarker Immunoassays in the Diagnosis of Preeclampsia: Calculating the sFlt1/PlGF Ratio Using the Cobas®e 411 Analyser
Black, C., & Costa, F. D. S. (2017) · Methods in molecular biology · doi:10.1007/978-1-4939-7498-6_2 · Cited by 3
Predictive Accuracy of Soluble FMS-Like Tyrosine Kinase-1/Placental Growth Factor Ratio for Preeclampsia in Japan: A Systematic Review
Yamazaki, T., Cerdeira, A. S., Agrawal, S., Koh, I., Sugimoto, J., Vatish, M., & Kudo, Y. (2020) · Hypertension Research in Pregnancy · doi:10.14390/jsshp.hrp2020-012 · Cited by 3
Detection of Key Proteins in Obstetric Preeclampsia by Nanocomposites Using Gold Nanoparticles/ DNA/Methylene Blue
Xie, H., Xu, S., Sang, L., Du, S., & Zhu, F. (2021) · Science of Advanced Materials · doi:10.1166/sam.2021.3919 · Cited by 3
Association between Adverse Maternal Clinical Outcomes and Imbalance of Cytokines and Angiogenic Factors in Preterm Preeclampsia
Nunes, P. R., Romão‐Veiga, M., Borges, V. T. M., Matias, M. L., Ribeiro, V. R., Costa, R., Peraçoli, M. T. S., & Peraçoli, J. C. (2021) · Revista Brasileira Ginecologia e Obstetrícia · doi:10.1055/s-0041-1735157 · Cited by 3
Cardiovascular and hemodynamic consequences of recombinant placental growth factor administration in Guinea pigs
Tan, A. Y., Kearney, K. R., Jenkins, C. J., Karumanchi, S. A., Bee, W. H., & Kussie, P. H. (2022) · Hypertension in Pregnancy · doi:10.1080/10641955.2022.2048390 · Cited by 3
“Women diagnosed with preeclampsia have lower levels of free PlGF than in normal pregnancies (7,28,29).”
Background
A mitochondrial regulator protein, MNRR1, is elevated in the maternal blood of women with preeclampsia
Suksai, M., Romero, R. J., Bosco, M., Gotsch, F., Jung, E., Chaemsaithong, P., Tarca, A. L., Gudicha, D. W., Gomez‐Lopez, N., Arenas‐Hernandez, M., et al. (2024) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.1080/14767058.2023.2297158 · Cited by 3

Authors: Rana, S., Powe, C. E., Salahuddin, S., Verlohren, S., Perschel, F. H., Levine, R. J., Lim, K.-H., Wenger, J. B., Thadhani, R., & Karumanchi, S. A.
Affiliations: National Institutes of Health (US)
ORCID: Rana, Sarosh
Powe, Camille E.
Verlohren, Stefan
Perschel, Frank H.
Wenger, Julia B.
Thadhani, Ravi
Karumanchi, S. Ananth
Venue: Circulation
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2012-02-21
Volume: 125
Issue: 7
Pages: 911-919
ISSN: 0009-7322 (ISSN-L)
1524-4539
DOI: 10.1161/circulationaha.111.054361
PMC: PMC3319742
OpenAlex: W2134502189
Cited by: 668
References: 39
Citations by year: 2026: 30 · 2025: 51 · 2024: 40 · 2023: 46 · 2022: 50 · 2021: 52 · 2020: 49 · 2019: 48 · 2018: 49 · 2017: 48 · 2016: 49 · 2015: 42 · 2014: 49 · 2013: 41 · 2012: 20
FWCI: 58.66
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Circulation (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: Howard Hughes Medical Institute
Topics: Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
Health Sciences › Medicine › Clinical Neurology › Neurological Complications and Syndromes
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Neonatal and fetal brain pathology
Keywords: preeclampsia, angiogenic factors, soluble fms-like tyrosine kinase-1, placental growth factor, sFlt-1/PlGF ratio, adverse maternal outcomes, perinatal outcomes, early-onset preeclampsia, proteinuria, hypertension, adverse outcome prediction, preterm birth, placental insufficiency, endothelial dysfunction, maternal morbidity
MeSH terms: Placenta Growth Factor, Adult, Female, Humans, Pre-Eclampsia, Pregnancy, Pregnancy Proteins, Prospective Studies, Risk, ROC Curve, Systole, Logistic Models, Vascular Endothelial Growth Factor Receptor-1

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Angiogenic Factors and the Risk of Adverse Outcomes in Women With Suspected Preeclampsia

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