Do Patients with A History of Pre-Eclampsia Have Elevated Levels of Coagulation and Angiogenic Markers Postpartum?

Abstract

Background: Pre-eclampsia (P-EC) is a pregnancy-specific disorder, characterised by placental insufficiency and endothelial dysfunction. It is a significant cause of maternal and fetal morbidity. Women with a history of P-EC have heightened risks of future cardiovascular and thromboembolic disease. In addition, pre- clamptic patients have elevated levels of clotting and angiogenic factors; however it is unclear whether these changes persist postpartum. Aims: The aim of this study was to investigate the relationship between haemostatic as well as angiogenic and anti-angiogenic factors in women with a past-history of P-EC, including vascular endothelial growth factor (VEGF), placental growth factor (PlGF), soluble fms-like tyrosine kinase-1 (sFlt-1) and soluble endoglin (sEng), in combination with tissue factor (TF) and TF pathway inhibitor (TFPI), also whether these factors were altered postpartum in women with a history of P-EC. Methods: The study followed a case-control design. Blood samples were obtained at 6-12 months postpartum from 21 primiparous women after a pregnancy affected by P-EC, and 21 women with a previously unaffected pregnancy. Plasma concentrations of each of the factors were determined using enzyme-linked immunosorbent assay. Results: Significant differences were not observed in levels of VEGF (p=0.068), PlGF (p=0.333), sFlt-1 (p=0.910), sEng (p=0.612), TF (p=0.260) or TFPI (p=0.786) between women with and without a history of pre-eclampsia. Additionally, no significant difference was found in the TF: TFPI ratio between case and control groups (p=0.734). Conclusion: This study does not support the hypothesis that levels of VEGF, PlGF, sFlt-1, sEng, TF or TFPI are altered in women with a history of P-EC compared to controls. However, we observed a weak positive association between all parameters measured. While we acknowledge that this is a pilot study and that the sample sizes is relatively small, our results suggest that circulating haemostatic, angiogenic and anti-angiogenic factors are not significantly altered in women with a past-history of P-EC.