Predicting Preeclampsia in Gestational Diabetes Mellitus using the sFlt-1/PlGF Ratio.

CONTEXT: The sFlt-1/PlGF ratio blood test can aid the prediction of preeclampsia (PE) in advance of a clinical diagnosis. Gestational diabetes mellitus (GDM) predisposes to PE, but may influence levels of these biomarkers independently of PE. OBJECTIVE: To determine whether the sFlt-1/PlGF ratio retains its clinical utility to predict PE in patients with GDM. DESIGN: Retrospective analysis of sFlt-1/PlGF ratio and associated clinical outcome data acquired between September 2016 and September 2022. SETTING: The Royal Women's Hospital, Melbourne, Australia. PATIENTS: 1,416 sFlt-1/PlGF ratio results from pregnant women with and without GDM, and with and without PE, referred for sFlt-1/PlGF testing. INTERVENTION: N/A. MAIN OUTCOME MEASURE: sFlt-1, PlGF and sFlt-1/PlGF ratio test results in relation to PE and GDM. RESULTS: There were no significant differences in the AUC, specificity, sensitivity, PPV or NPV between the PE + No GDM and PE + GDM groups in both the 0-7 and 8-14 day before delivery categories. In the 0-7 day category the PE + No GDM group had a AUC of 0.82 (95% CI: 0.79-0.87), sensitivity of 85.3% (95% CI: 80.8% - 89.1%), NPV of 92.7% (95% CI: 90.5% - 94.5%), and the PE + GDM group had an AUC of 0.87 (95% CI: 0.82-0.93), sensitivity of 89.4% (95% CI: 76.9% - 96.5%) and NPV of 94.8% (95% CI: 88.7% - 97.7%). CONCLUSIONS: The results of this investigation indicate that whilst GDM may lead to changes in the sFlt-1/PlGF ratio, the sFlt-1/PlGF ratio test retains its clinical utility in predicting PE onset.