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.
Levine RJ, Epstein FH, Karumanchi SA. Urinary Placental Growth Factor and Preeclampsia—Reply. JAMA. 2005;293(15):1857–1858. doi:10.1001/jama.293.15.1857-b
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