Abstract
Background: Preterm delivery (PTD) may be characterized by altered interrelationships among angiogenic factors and measures of placental function. We analyzed the longitudinal relationship between maternal serum concentrations of soluble fms-like tyrosine kinase I (sFltI), an important antiangiogenic factor, and uterine artery resistance in pregnancies resulting in preterm and term deliveries. Methods: Data were collected in a longitudinal cohort study involving 278 women monitored at 6 to 10, 10 to 14, 16 to 20, 22 to 26, and 32 to 36 weeks of gestation. Concentrations of maternal serum sFltI were determined using solidphase enzyme-linked immunosorbent assay, and uterine artery resistance indices (RI) were measured by Doppler velocimetry at each interval. Preterm delivery was defined as birth before 37-weeks completed gestation. Data analyses used multivariable repeated measures regression models. Results: Uterine artery RI decreased across gestation. As pregnancy progressed, RI trajectories diverged for term and preterm deliveries; the mean RI was significantly higher in third trimester for pregnancies resulting in PTD (P = .08). sFltI was stable through 21 3/7 weeks of gestation and then increased rapidly; women who delivered preterm had significantly higher sFltI levels in the third trimester (P =.04). The relationship between uterine artery RI and sFltI from the prior visit was significantly different between the groups (P < .0001). For term deliveries, higher sFltI concentrations were associated with a smaller RI at the subsequent visit (β = −.08, 95% confidence interval [CI]: −0.14 to −0.02). For PTD, higher sFltI concentrations were associated with a larger uterine artery RI (β = .14, 95% CI: 0.06 to 0.22). Conclusion: PTD is characterized by altered relationships between angiogenic factors and placental vascular blood flow starting in early pregnancy.
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Straughen, J.K., Misra, D.P., Helmkamp, L. et al. Preterm Delivery as a Unique Pathophysiologic State Characterized by Maternal Soluble FMS-Like Tyrosine Kinase 1 and Uterine Artery Resistance During Pregnancy: A Longitudinal Cohort Study. Reprod. Sci. 24, 1583–1589 (2017). https://doi.org/10.1177/1933719117698574
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DOI: https://doi.org/10.1177/1933719117698574