Early postpartum changes in circulating pro- and anti-angiogenic factors in early-onset and late-onset pre-eclampsia

Background. Pre-eclampsia is associated with altered plasma concentrations of the pro- and anti-angiogenic factors placental growth factor (PlGF), vascular endothelial growth factor-A (VEGF-A) and soluble fms-like tyrosine kinase 1 (sFlt1). However, there is insufficient knowledge about how these concentrations change after delivery, and whether the changes differ between early-onset and late-onset pre-eclampsia. Methods. Plasma concentrations of sFlt1, PlGF and VEGF-A were measured before delivery and on days 1, 3 and 7 postpartum in women with early-onset (24-32 weeks' gestation) (n=18) and late-onset pre-eclampsia (35-42 weeks' gestation) (n=20) and in control groups delivered in corresponding weeks of gestation. Results. All groups showed a rapid decrease in median sFlt1 concentration postpartum. Women with late-onset pre-eclampsia did not differ in sFlt1 concentration from controls on day 1 postpartum, whereas women with early-onset pre-eclampsia displayed a persistently elevated sFlt1 concentration on day 7 postpartum compared with controls. PlGF concentrations did not change from before delivery to any time point postpartum in the pre-eclampsia groups. VEGF-A concentrations were slightly increased on day 7 postpartum in both pre-eclampsia and control groups compared to concentrations prior to delivery. Conclusion. Median sFlt1 concentrations decreased rapidly postpartum in all groups, but remained higher in early-onset pre-eclampsia than controls on day 7. Postpartum, the median PlGF concentrations were similar to the concentrations measured before delivery in women with pre-eclampsia.