Placental growth factor as an indicator of maternal cardiovascular risk after pregnancy - Benschop 2020

Background: During pregnancy, levels of placental growth factor (PlGF) increase and reach their peak towards the end of mid-pregnancy. Low levels of PlGF during pregnancy have been associated with pregnancy complications and increased risk of cardiovascular disease in later life. The hypothesis of this study was that low PlGF concentrations, particularly during mid-pregnancy, not only identify women at risk for pregnancy complications, but also those with a higher burden of cardiovascular risk factors after pregnancy, regardless of pregnancy outcome. Methods: This was a prospective cohort study involving 5529 women, in which we calculated the multiple of the medians of early pregnancy and mid-pregnancy PlGF concentrations adjusted for gestational age. Information on pregnancy complications (pre-eclampsia, small for gestational age, and spontaneous preterm birth) was obtained from hospital registries. Six years after pregnancy, we measured maternal blood pressure (systolic and diastolic), cardiac structure (aortic root diameter, left atrial diameter, left ventricular mass, and fractional shortening), carotid-femoral pulse wave velocity, and central retinal arteriolar and venular calibers. Blood pressure was also measured nine years after pregnancy. Results: The women were, on average, 29.8 years old during pregnancy, mostly of European descent (55.2%), and 14.8% had a pregnancy complication. Quartile analysis showed that women with mid-pregnancy PlGF in the lowest quartile (the low PlGF subset) had a larger aortic root diameter, left atrial diameter, left ventricular mass, and systolic blood pressure six years after pregnancy than women with the highest PlGF. Linear regression analysis showed that higher mid-pregnancy PlGF concentrations were associated with a smaller aortic root diameter, left atrial diameter, lower left ventricular mass, and systolic blood pressure. These differences persisted even after excluding women with complicated pregnancies. Conclusions: Women with low PlGF in mid-pregnancy have a greater aortic root diameter, left atrial diameter, left ventricular mass, and higher systolic blood pressure six and nine years after pregnancy compared to women with higher PlGF, including those with uncomplicated pregnancies. Lower PlGF concentrations in mid-pregnancy may have pathophysiological implications and provide insight into identifying pathways contributing to a greater burden of cardiovascular risk factors.

Benschop L, Schalekamp-Timmermans S, Broere-Brown ZA, Roeters van Lennep JE, Jaddoe VWV, Roos-Hesselink JW, Ikram MK, Steegers EAP, Roberts JM, Gandley RE. Placental Growth Factor as an Indicator of Maternal Cardiovascular Risk After Pregnancy. Circulation. 2019 Apr 2;139(14):1698-1709. doi: 10.1161/CIRCULATIONAHA.118.036632. PMID: 30760000; PMCID: PMC6443459.