Objective: Preeclampsia in a first pregnancy confers an increased risk of recurrence in a subsequent pregnancy. Yet, disease severity is usually attenuated when the subsequent pregnancy is conceived with the same partner, whereas pregnancies with a different partner often exhibit a severity profile similar to that of the index pregnancy. The soluble Fms-like tyrosine kinase-1/placental growth factor ratio (sFlt-1/PlGF) ratio is a well-known biomarker of preeclampsia severity. This study evaluated this ratio in a subsequent pregnancy after an index pregnancy complicated by preeclampsia. Design and method: This is a secondary analysis of two prospective cohorts (PRERATIO, n=620; PRERISK, n=877) including women with suspected or confirmed preeclampsia according to similar inclusion criteria. Patients with preeclampsia in an index pregnancy and participation during a subsequent pregnancy were identified. Angiogenic markers (sFlt-1/PlGF ratio) at inclusion were compared between pregnancies within individuals. Results: Ten women with preeclampsia in the index pregnancy were included of whom seven developed recurrent preeclampsia. In nine patients the subsequent pregnancy was characterized by a substantially lower sFlt-1 concentration (median -4910 pg/mL, interquartile range IQR 3301-8426 pg/mL; P=0.008) and higher PlGF concentration (+251 pg/mL, IQR 54-601; P=0.015), leading to a significantly lower sFlt-1/PlGF ratio (P=0.021), despite recurrent disease in most cases. In contrast, one patient who developed preeclampsia in both pregnancies the sFlt-1 increased from 2318 to 11196 pg/mL, PlGF decreased from 812 to 24 pg/mL, and the ratio increased from 3 to 472. Importantly, this pregnancy was conceived with a different partner than the index pregnancy. Conclusions: Following an initial pregnancy complicated by preeclampsia, the sFlt-1/PlGF ratio in a subsequent pregnancy tends to ameliorate regardless of recurrent preeclampsia. Yet, the opposite occurred when the pregnancy was conceived with a different partner.
Kluivers et al. (Fri,) studied this question.