Prediction using serum glycosylated fibronectin of imminent pre‐eclampsia in women with new‐onset hypertension

Abstract

ABSTRACTObjectiveTo compare the predictive performance for delivery with pre‐eclampsia (PE) within 2 weeks after assessment in women with new‐onset hypertension at 24–41 weeks' gestation between serum glycosylated fibronectin (GlyFn) concentration, serum placental growth factor (PlGF) concentration and soluble fms‐like tyrosine kinase‐1 (sFlt‐1) to PlGF concentration ratio.MethodsThis was a prospective observational study of 409 women with a singleton pregnancy presenting at 24–41 weeks' gestation with new‐onset hypertension. The recommended cut‐off for sFlt‐1/PlGF ratio for the prediction of PE in the platform used in this study is 85; the appropriate cut‐offs for GlyFn and PlGF were determined to achieve the same screen‐positive rate as that of sFlt‐1/PlGF ratio > 85. We then compared the predictive performance for delivery with PE within 2 weeks after presentation between GlyFn, PlGF and sFlt‐1/PlGF, both overall and in subgroups according to gestational age at presentation.ResultsDelivery with PE within 2 weeks occurred in 93 (22.7%) cases. The screen‐positive rate for sFlt‐1/PlGF ratio > 85 was 46.2%. The cut‐off corresponding to a screen‐positive rate of 46.2% was 75 pg/mL for PlGF and 510 µg/mL for GlyFn. The overall detection rate for delivery with PE within 2 weeks after presentation was 62.4% (95% CI, 51.7–72.2%) for GlyFn and sFlt‐1/PlGF and 60.2% (95% CI, 49.5–70.2%) for PlGF. In all women who delivered with PE within 2 weeks after presentation at < 34 weeks' gestation and in about 60–70% of those presenting at < 38 weeks, GlyFn and sFlt‐1/PlGF were increased and PlGF was reduced. However, the screen‐positive rate for these tests was very high at about 45%. The predictive performance for delivery with PE within 2 weeks after presentation at ≥ 38 weeks' gestation was poorer for all three methods of screening, with detection rates of 47–63% at screen‐positive rates of 40–50%.ConclusionsIn women with new‐onset hypertension, the predictive performance for delivery with PE within 2 weeks after presentation for serum GlyFn is similar to that of PlGF and the sFlt‐1/PlGF ratio, but GlyFn may be the preferred option because it is a rapid point‐of‐care test. However, the predictive performance for all tests is relatively poor. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.