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Letters
April 20, 2005

Urinary Placental Growth Factor and Preeclampsia—Reply

JAMA. 2005;293(15):1857-1858. doi:10.1001/jama.293.15.1857-b

In Reply: Drs Carbillon and Uzan raise the question of whether concentrations of PlGF might be used to distinguish pregnancies with growth-retarded fetuses due to uteroplacental insufficiency from those with constitutionally small fetuses. While this is an important question, the Calcium for Preeclampsia Prevention trial did not include uterine artery Doppler ultrasonography data, so we were unable to make this distinction.

In our main study, urinary PlGF in the lowest quartile of the distribution of specimens obtained at 21 to 32 weeks of gestation from women who remained normotensive throughout pregnancy was strongly associated with the subsequent development of preeclampsia before 37 weeks. Low PlGF at 21 to 32 weeks was associated with an odds ratio for preeclampsia before 37 weeks that was 14-fold greater than that for preeclampsia occurring at later gestational age, regardless of the presence or absence of an SGA infant (odds ratios for the lowest vs highest quartiles, 31.3 at <37 weeks and 2.2 at ≥37 weeks). We also reported a strong association between the lowest quartile of urinary PlGF at 21 to 32 weeks and the subsequent development (at any gestational age) of preeclampsia complicated by an SGA infant. We did not detect evidence of significant reductions in urinary PlGF at 21 to 32 weeks in women with an SGA infant who remained normotensive throughout pregnancy or in women who developed gestational hypertension without proteinuria, conditions that are not infrequent and whose pathogenesis may share similarities with preeclampsia.

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