Role of angiogenic growth factors in the pathogenesis of preeclampsia and placental insufficiency

Objective. To study the role of proangiogenic and antiangiogenic growth factors in the pathogenesis of placental insufficiency (PI) and preeclampsia (PE). Subjects and methods. Two hundred and fifty-four pregnant women were examined. A study group consisted of 116 patients with PI and fetal growth retardation syndrome (FGRS) (Group 1); a comparison group included 86 pregnant women with PE (Group 2); a control group comprised 52 somatically healthy patients with physiological pregnancy (Group 3). The study group was divided into 3 subgroups: 1A) 44pregnant women with grade I FGRS; 1B) 38 pregnant women with grade II FGRS; 1C) 34 pregnant women with grade III FGRS. The comparison group was divided into 2 subgroups: 2a) 50 pregnant women with moderate PE; 2b) 36 pregnant women with severe PE. Results. There were significant differences in the levels of vascular growth factors in the pregnant women with PI and FGRS versus the patients with PE and the healthy pregnant women. In the pregnant women of the study group, sFlt-1 levels were 5.5 times higher than those in the control group. In the pregnant women with PE, this indicator was 2- and 11-fold in those with PI and in healthy women, respectively. In the pregnant women of the study group, s-Eng levels were 3.3 times higher than those in the control group. In the pregnant women with PE, this indicator was 4- and 13-fold in those with PI and in the healthy women, respectively. In the pregnant women of the study group, proangiogenic growth factor (PlGF) concentrations were 1.5 times less than those in the healthy pregnant women. In the pregnant women with PE, this indicator was 5 and 8 times lower than in those with PI and in the healthy women, respectively. In the study group patients, the angiogenic coefficient K was 25 times greater than that in the healthy pregnant women. K was 2.7- and 67-fold in PE and physiological pregnancy, respectively. Conclusion. The impairments in the formation and functioning of a fetoplacental unit, which are characterized by a decrease in the level of PlGF and an increase in that of the antiangiogenic growth factors sFlt-1 and s-Eng, are specific to both PE and PI. However, the severity of angiogenic imbalance varies. PE is characterized by more significant angiogenic imbalance with a predominance of antiangiogenic activity, leading to not only isolated placental insufficiency, but also to systemic changes, the disruption of maternal adaptation mechanisms, and the development of multiorgan dysfunction, which threatens the life and health of not only the fetus, but also those of the mother.

angiogenesis, placental insufficiency, preeclampsia, fetal growth retardation syndrome, vascular growth factors, angiogenic coeff icient