Objective: In May 2009, after considering short and long-term maternal/child outcomes, the Institute of Medicine (IOM) revised recommendations for gestational weight gain (GWG); however preeclampsia was dismissed due to insufficient evidence. Our objective was to evaluate preeclampsia risk by angiogenic-biomarker profile by both BMI and GWGadherence. Given numerous studies showing adipose tissue\u27s ability to stimulate angiogenesis, we hypothesized that overweight/obese (OW-OB) women and over-gainers (OG) would have altered angiogenic profiles as compared to underweight/normal-weight (UN) women and under-/appropriate-gainers (U-AG), respectively.
Methods: Between 5/04-1/06, serial serum specimens collected from 94 women at high preeclampsia risk between 22-36 weeks. Soluble fms-like tyrosine kinase-1 (sFlt1), placental growth factor (PlGF) and soluble endoglin (sEng) measured by ELISA. BMI and GWG adherence categories determined by 1990 IOM recommendations. Within-women correlation and right-skewness handled by estimating linear mixed models for ln-transformed biomarkers and then exponentiating on ln scale (i.e.geometric means). T-test compared means in 3 windows.
Results: Analytic sample included 82 subjects (342 specimens) without multiples or pregnancy-related hypertension diagnosis. Mean sFlt1 lower in all windows in OW-OB compared to U-N - significant only at 22-26wks [506.2 (95% CI 438.1-584.9) vs 745.5 (95% CI 595.9-932.6) p=0.04] and in OG compared to U-AG with significant comparisons (p=0.05) [22-26wks: 492.1 (95% CI 420.1-576.3) vs 691.3 (95% CI 574.0-832.6); 27-30 wks: 570.1 (95% CI 488.1-665.9) vs 788.8 (95% CI 656.8-947.4)]. Mean PIGF lower in all windows in OW-OB compared to U-N [22-26wks: 430.5 (95% CI 359.0-516.3) vs 588.6 (95% CI 444.3-779.7) p=0.06; 27-30wks: 475.8 (95% CI 398.7-567.8) vs 811.8 (95% CI 614.3-1072.9) p=0.005; 31-36wks: 428.5 (95% CI 358.0-513.0) vs 724.6 (95% CI 548.5-957.1) p=0.01] and in OG compared to U-AG with no significant comparisons. Mean ratio [(sFlt1+sEng):PIGF] trended higher in OW-OB compared to U-N women at 27-30 and 31-36 wks and in OG compared to UAG at 31-36wks; however no windows with significant comparisons.
Conclusion: Findings suggest trends that OW-OB BMI and excessive GWG associated with angiogenic biomarker profiles consistent with higher preeclampsia risk. Exploratory study limited by small numbers. BMI and GWG as potentially modifiable factors merit furtherinvestigation for preeclampsia risk alteration.
Presented at the Society of Gynecologic Investigation 2011 Annual Meeting, March 2011, Miami Beach, Florida

Liao, Xun

Maynard, Sharon E.

Moore Simas, Tiffany A.

English

eScholarship@UMMS

University of Massachusetts Medical School eScholarship@UMMS Obstetrics and Gynecology Publications and Presentations Obstetrics and Gynecology 2011-3 BMI, Gestational Weight Gain and Angiogenic Biomarker Profiles for Preeclampsia Risk Tiffany A. Moore Simas University of Massachusetts Medical School Et al. Let us know how access to this document benefits you. Follow this and additional works at: https://escholarship.umassmed.edu/obgyn_pp  Part of the Obstetrics and Gynecology Commons Repository Citation Moore Simas TA, Maynard SE, Liao X. (2011). BMI, Gestational Weight Gain and Angiogenic Biomarker Profiles for Preeclampsia Risk. Obstetrics and Gynecology Publications and Presentations. Retrieved from https://escholarship.umassmed.edu/obgyn_pp/1 This material is brought to you by eScholarship@UMMS. It has been accepted for inclusion in Obstetrics and Gynecology Publications and Presentations by an authorized administrator of eScholarship@UMMS. For more information, please contact Lisa.Palmer@umassmed.edu. BMI, Gestational Weight Gain & Angiogenic Biomarker Profiles for Preeclampsia RiskTiffany A. Moore Simas, MD, MPH, MEd1; Sharon E. Maynard, MD2 and Xun Liao, MS11Department of Ob/Gyn, University of Massachusetts Medical School, Worcester, Massachusetts, United States2Department of Medicine, George Washington University, Washington, District of ColumbiaAbstractObjective: In May 2009, after considering short and long-term maternal/child outcomes, the Institute of Medicine (IOM) revised recommendations for gestational weight gain (GWG); however preeclampsia was dismissed due to insufficient evidence. Our objective was to evaluate preeclampsia risk by angiogenic-biomarker profile by both BMI and GWG-adherence. Given numerous studies showing adipose tissue's ability to stimulate angiogenesis, we hypothesized that overweight/obese (OW-OB) women and over-gainers (OG) would have altered angiogenic profiles as compared to underweight/normal-weight (U-N) women and under-/appropriate-gainers (U-AG), respectively. Methods: Between 5/04-1/06, serial serum specimens collected from 94 women at high preeclampsia risk between 22-36 weeks. Soluble fms-like tyrosine kinase-1 (sFlt1), placental growth factor (PlGF) and soluble endoglin (sEng) measured by ELISA. BMI and GWG adherence categories determined by 1990 IOM recommendations. Within-women correlation and right-skewness handled by estimating linear mixed models for ln-transformed biomarkers and then exponentiating on ln scale (i.e.geometric means). T-test compared means in 3 windows. Results: Analytic sample included 82 subjects (342 specimens) without multiples or pregnancy-related hypertension diagnosis. Mean sFlt1 lower in all windows in OW-OB compared to U-N - significant only at 22-26wks [506.2(95%CI 438.1-584.9) vs 745.5(95%CI 595.9-932.6) p=0.04] and in OG compared to U-AG with significant comparisons (p=0.05) [22-26wks: 492.1(95%CI 420.1-576.3) vs 691.3(95%CI 574.0-832.6); 27-30wks: 570.1(95%CI488.1-665.9) vs 788.8(95%CI 656.8-947.4)]. Mean PlGF lower in all windows in OW-OB compared to U-N [22-26wks: 430.5(95%CI 359.0-516.3) vs 588.6(95%CI 444.3-779.7) p=0.06; 27-30wks: 475.8(95%CI 398.7-567.8) vs 811.8(95%CI 614.3-1072.9) p=0.005; 31-36wks: 428.5(95%CI 358.0-513.0) vs 724.6(95%CI 548.5-957.1) p=0.01] and in OG compared to U-AG with no significant comparisons. Mean ratio [(sFlt1+sEng):PlGF] trended higher in OW-OB compared to U-N women at 27-30 and 31-36wks and in OG compared to U-AG at 31-36wks; however no windows with significant comparisons. Conclusion: Findings suggest trends that OW-OB BMI and excessive GWG associated with angiogenic biomarker profiles consistent with higher preeclampsia risk. Exploratory study limited by small numbers. BMI and GWG as potentially modifiable factors merit further investigation for preeclampsia risk alteration.Background• In May 2009, after considering short and long-term maternal/child outcomes, the Institute of Medicine (IOM) revised recommendations for gestational weight gain (GWG); however preeclampsia was dismissed due to insufficient evidence. IOM 2009• Since change in recommendations, epidemiologic studies have since been published that support an association between GWG adherence and hypertensive disease of pregnancy.AJOG 2009;200(2):167.e1-7• Numerous studies have revealed adipose tissue's ability to stimulate angiogenesisCardiovascular Res 2008;78(2):286-93Conclusion• Findings suggest trends that OW-OB BMI and excessive GWG associated with angiogenic biomarker profiles consistent with higher preeclampsia risk by end of gestation.• BMI and GWG as potentially modifiable factors merit further investigation for preeclampsia risk alteration.HypothesisMaterials & Methods Pregnant subjects  <24 weeks gestation enrolled from outpatient prenatal clinics at UMass Memorial Health Care between May 2004 and January 2006. Each subject had >1 of the following risk factors for preeclampsia:Inclusion Criteria                       RRChronic HTN 2.37Renal Disease/CKD -----Pregestational DM  3.56History of Preeclampsia              7.19Teen Pregnancy (≤ 18)                2.98Multi-fetal gestation    2.93 (twins)2.83 (triplets)Obesity (BMI > 30)     2.47APL Ab Syndrome                      9.72SLE                                                 -----Duckitt K & Harrington D. BMJ. 2005 Subjects recruited 127Exclusionsmissing outcomes 3gestational HTN                   5multiple gestationsa 25preeclampsia diagnosisb 12Subjects included in analyses 82(342 samples)Excluded due to association with altered angiogenic profile:aMultiple gestations (n=20)  Maynard et al, AJOG, 2008;198:200bHypertensive diseases of pregnancy (gestational HTN & preeclampsia)Moore Simas et al, AJOG, 2007;197:244.e1-244.e8 sFlt1, PlGF and sEndoglin levels were measured by ELISA BMI & GWG adherence categories by 1990 IOM recommendationsAdherence defined by GWG and GA @ last prenatal visit subtracted from pre-pregnancy weight; thus preterm and term deliveries includedStatistical Analysis• Demographic comparisons utilized Fisher exact test for categorical variables and Wilcoxon rank sum test for continuous variables                      (see Table 1)• Within-women correlation and right-skewness handled by estimating linear mixed models for ln-transformed biomarkers and then exponentiating on ln scale (i.e., geometric means). • Geometric mean and 95% confidence intervals displayed for sFlt1, PlGF and (sFlt1+sEng):PlGF in each of 3 gestational-age windows for UW-N vs. OW-OB BMI and Under-Appropriate vs. Over-gainers (see figures 1-6)• T-test compared means in 3 windows.  We hypothesized that overweight/obese (OW-OB) women and over-gainers (OG) would have altered angiogenic profiles as compared to underweight/normal-weight (U-N) women and under-/appropriate-gainers (U-AG), respectively.• Analytic sample included 82 subjects (342 specimens).• See Table 1 for Demographic Comparisons.• BMI Comparisons (see Figures1–3)• Mean sFlt1 lower in all windows in OW-OB compared to U-N (Figure 1)• Mean PlGF lower in all windows in OW-OB compared to U-N (Figure 2)• Mean ratio [(sFlt1+sEng):PlGF] trended higher in OW-OB compared to U-N women at 27-30 and 31-36wks (Figure 3)• GWG Adherence Comparisons (see Figures 4–6)• Mean sFlt1 lower in all windows in OG compared to U-AG (Figure 4)• Mean PLGF lower in all windows in OG compared to U-AG (Figure 5)• Mean ratio [(sFlt1+sEng):PlGF] trended higher in OG compared to U-AG at 31-36wks (Figure 6)Table 1. Demographic comparisonsObjectiveTo evaluate preeclampsia risk by angiogenic-biomarker profile by both BMI and GWG-adherence.Demographic CharacteristicsBMI Categories GWG Adherence CategoriesUnderweight-NormalOverwgt-ObeseP-ValueUnder/ApproprGainOver-GainP-ValueMean±SD Mean±SD Mean±SD Mean±SDAge (years) 25.9±8.5 31.1±6.6 0.01 29.6±7.9 29.5±7.4 NSGravity 2.4±1.7 2.9±1.8 NS 2.9±2.1 2.7±1.5 NSLiving Children 0.8±1.1 1.0±1.0 NS 0.9±1.1 0.9±1.0 NSGA @ first PNV (wk)11.8±4.4 12.0±6.0 NS 11.8±4.8 12.0±6.3 NSSBP @ first PNV (mmHg)114.0±12.5 119.5±13.7 NS 117.1±14.2 119.1±13.1 NSDBP at first PNV (mmHg)67.1±5.1 70.8±9.6 NS 70.0±8.4 69.9±9.4 NSGA at delivery (wks)38.6±2.2 38.0±2.7 NS 38.6±2.0 37.9±2.8 NSPlacenta weight (g)443.8±90.1 443.6±206.9NS 526.4±155.7 371.3±176.2 NSN (%) N (%) N (%) N (%)Race/ethnicityWhiteHispanicBlackOther13 (54.2)10 (41.7)0 (0)1 (4.2)35 (60.3)13 (22.4)9 (15.5)1 (1.7)0.0519 (55.9)10 (29.4)4 (11.8)1 (2.9)29 (60.4)13 (27.1)5 (10.4)1 (2.9)NSSmoking StatusCurrentPrior PregnancyNever1 (4.2)6 (25.0)17 (70.3)6 (10.3)9 (15.5)43 (74.1)NS4 (11.8)5 (14.7)25 (73.5)3 (6.3)10 (20.8)35 (72.9)NSChronic HTN 3 (12.5) 17 (29.3) NS 9 (26.5) 11 (22.9) NSPregestational DM6 (25.0) 22 (37.9) NS 10 (29.4) 18 (37.5) NSRenal Disease 4 (16.7) 1 (1.7) 0.02 5 (14.7) 0 (0) 0.01Adolescent Pregnancy8 (33.3) 6 (10.3) 0.02 7 (20.6) 7 (14.6) NSHistory Preeclampsia4 (16.7) 9 (15.5) NS 7 (20.6) 6 (12.5) NSLupus 4 (16.7) 2 (3.5) NS 4 (11.8) 2 (4.2) NSAntiphospholipidSyndrome0 (0) 2 (3.5) NS 0 (0) 2 (4.2) NS• Small sample size required collapsing of BMI and GWG-adherence categories; thus unable to look at adherence within each BMI category• Secondary analysis not powered for this exploratory analysis• Only had total GWG at end of pregnancyLimitationsPre-pregnancy BMI CategoryPre-pregnancy BMI* (kg/m2)Total GWG at 40 weeksUnderweight (U) <19.8 28-40 lbsNormal weight  (N) 19.8-26.0 25-35 lbsOverweight (OW) 26.1-29.0 15-25 lbsObese (OB) >29.0 At least 15 lbsResults20040060080010001200140022-26 27-30 31-36SFlt1 (pg/ml)Gestational Age (Weeks)2004006008001000120022-26 27-30 31-36PlGF(pg/ml)01234522-26 27-30 31-36(SFlt1+sEng)/PlGFGestational Age (Weeks)Under-/Normal-weightOverweight/Obese1.  Geometric mean sFlt1 (95% CI)  3. Geometric mean (sFlt1+sEng)/PlGF (95% CI)  2.  Geometric mean PlGF (95% CI)  Figures 1-3.  Angiogenic biomarker profiles comparing under-/normal-weight to overweight/obese at 3 gestational age windows BMI Category(# specimen/ # women)22-26 weeks 27-30 weeks 31-36 weeksUnderweight (<19.8) 5/4 6/3 7/4Normal weight (19.8-26.0) 22/18 27/18 29/17Overweight (26.0-29.0) 22/16 23/15 28/14Obese (>29.0) 47/35 63/37 63/3620040060080010001200140022-26 27-30 31-36SFlt1 (pg/ml)Gestational Age (Weeks)200400600800100022-26 27-30 31-36PlGF(pg/ml) 0123422-26 27-30 31-36(SFlt1+sEng)/PlGFGestational Age (Weeks)Under/Appropriate-gainersOver-gainers4. Geometric mean sFlt1 (95% CI) 6. Geometric mean (sFlt1+sEng)/PlGF (95% CI) 5. Geometric mean PlGF (95% CI) GWG BMI-specific Adherence Category(# specimen/ # women)22-26 weeks 27-30 weeks 31-36 weeksUnder gainer 24/17 24/15 27/14Appropriate gainer 18/13 25/15 29/15Over gainer 54/43 70/43 71/42Figures 4-6.  Angiogenic biomarker profiles comparing under/appropriate gainers to over-gainers at 3 gestational age windows p=0.04p=0.05p=0.01p=0.01p=0.06p=0.05

BMI, Gestational Weight Gain and Angiogenic Biomarker Profiles for Preeclampsia Risk

Background   In May 2009, after considering short and long-term maternal/child outcomes, the Institute of Medicine (IOM) revised recommendations for gestational weight gain (GWG); however preeclampsia was dismissed due to insufficient evidence. IOM 2009   Since change in recommendations, epidemiologic studies have since been published that support an association between GWG adherence and hypertensive disease of pregnancy. AJOG 2009;200(2):167.e1-7   Numerous studies have revealed adipose tissue\u27s ability to stimulate angiogenesis. Cardiovascular Res 2008;78(2):286-93 
Objective
To evaluate preeclampsia risk by angiogenic-biomarker profile by both BMI and GWG-adherence.
Hypothesis
We hypothesized that overweight/obese (OW-OB) women and over-gainers (OG) would have altered angiogenic profiles as compared to underweight/normal-weight (U-N) women and under-/appropriate-gainers (U-AG), respectively.
Conclusions   Findings suggest trends that OW-OB BMI and excessive GWG associated with angiogenic biomarker profiles consistent with higher preeclampsia risk by end of gestation.   BMI and GWG as potentially modifiable factors merit further investigation for preeclampsia risk alteration

University of Massachusetts Medical School eScholarship@UMMS UMass Center for Clinical and Translational Science Research Retreat 2011 UMass Center for Clinical and Translational Science Research Retreat May 20th, 5:00 PM - 7:00 PM BMI, Gestational Weight Gain and Angiogenic Biomarker Profiles for Preeclampsia Risk Tiffany A. Moore Simas University of Massachusetts Medical School Et al. Let us know how access to this document benefits you. Follow this and additional works at: https://escholarship.umassmed.edu/cts_retreat  Part of the Clinical Epidemiology Commons, and the Obstetrics and Gynecology Commons Moore Simas TA, Maynard SE, Liao X. (2011). BMI, Gestational Weight Gain and Angiogenic Biomarker Profiles for Preeclampsia Risk. UMass Center for Clinical and Translational Science Research Retreat. Retrieved from https://escholarship.umassmed.edu/cts_retreat/2011/posters/11 Creative Commons License This work is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 3.0 License. This material is brought to you by eScholarship@UMMS. It has been accepted for inclusion in UMass Center for Clinical and Translational Science Research Retreat by an authorized administrator of eScholarship@UMMS. For more information, please contact Lisa.Palmer@umassmed.edu. Demographic CharacteristicsBMI Categories GWG Adherence CategoriesUnderweight-NormalOverwgt-ObeseP-ValueUnder/ApproprGainOver-GainP-ValueMean±SD Mean±SD Mean±SD Mean±SDAge (years) 25.9±8.5 31.1±6.6 0.01 29.6±7.9 29.5±7.4 NSGravity 2.4±1.7 2.9±1.8 NS 2.9±2.1 2.7±1.5 NSLiving Children 0.8±1.1 1.0±1.0 NS 0.9±1.1 0.9±1.0 NSGA @ first PNV (wk) 11.8±4.4 12.0±6.0 NS 11.8±4.8 12.0±6.3 NSSBP @ first PNV (mmHg) 114.0±12.5 119.5±13.7 NS 117.1±14.2 119.1±13.1 NSDBP at first PNV (mmHg) 67.1±5.1 70.8±9.6 NS 70.0±8.4 69.9±9.4 NSGA at delivery (wks) 38.6±2.2 38.0±2.7 NS 38.6±2.0 37.9±2.8 NSPlacenta weight (g) 443.8±90.1 443.6±206.9 NS 526.4±155.7 371.3±176.2 NSN (%) N (%) N (%) N (%)Race/ethnicityWhiteHispanicBlackOther13 (54.2)10 (41.7)0 (0)1 (4.2)35 (60.3)13 (22.4)9 (15.5)1 (1.7)0.0519 (55.9)10 (29.4)4 (11.8)1 (2.9)29 (60.4)13 (27.1)5 (10.4)1 (2.9)NSSmoking StatusCurrentPrior PregnancyNever1 (4.2)6 (25.0)17 (70.3)6 (10.3)9 (15.5)43 (74.1)NS4 (11.8)5 (14.7)25 (73.5)3 (6.3)10 (20.8)35 (72.9)NSChronic HTN 3 (12.5) 17 (29.3) NS 9 (26.5) 11 (22.9) NSPregestational DM 6 (25.0) 22 (37.9) NS 10 (29.4) 18 (37.5) NSRenal Disease 4 (16.7) 1 (1.7) 0.02 5 (14.7) 0 (0) 0.01Adolescent Pregnancy 8 (33.3) 6 (10.3) 0.02 7 (20.6) 7 (14.6) NSHistory Preeclampsia 4 (16.7) 9 (15.5) NS 7 (20.6) 6 (12.5) NSLupus 4 (16.7) 2 (3.5) NS 4 (11.8) 2 (4.2) NSAntiphospholipid Syndrome 0 (0) 2 (3.5) NS 0 (0) 2 (4.2) NS• In May 2009, after considering short and long-term maternal/child outcomes, the Institute of Medicine (IOM) revised recommendations for gestational weight gain (GWG); however preeclampsia was dismissed due to insufficient evidence. IOM 2009• Since change in recommendations, epidemiologic studies have since been published that support an association between GWG adherence and hypertensive disease of pregnancy.AJOG 2009;200(2):167.e1-7• Numerous studies have revealed adipose tissue's ability to stimulate angiogenesisCardiovascular Res 2008;78(2):286-93BMI, Gestational Weight Gain & Angiogenic Biomarker Profiles for Preeclampsia RiskTiffany A. Moore Simas, MD, MPH, MEd1; Sharon E. Maynard, MD2 and Xun Liao, MS11Department of Ob/Gyn, University of Massachusetts Medical School, Worcester, Massachusetts, United States2Department of Medicine, George Washington University, Washington, District of ColumbiaBackgroundMaterials & MethodsObjectiveLimitationsResultsTo evaluate preeclampsia risk by angiogenic-biomarker profile by                         both BMI and GWG-adherence.We hypothesized that overweight/obese (OW-OB) women and over-gainers (OG) would have altered angiogenic profiles as compared to underweight/normal-weight (U-N) women and under-/appropriate-gainers (U-AG), respectively. Pregnant subjects  <24 weeks gestation enrolled from outpatient prenatal clinics at UMass Memorial Health Care between May 2004 and January 2006. Each subject had >1 of the following risk factors for preeclampsia:Inclusion Criteria                       RRChronic HTN 2.37Renal Disease/CKD -----Pregestational DM  3.56History of Preeclampsia              7.19Teen Pregnancy (≤ 18)                2.98Multi-fetal gestation    2.93 (twins)2.83 (triplets)Obesity (BMI > 30)     2.47APL Ab Syndrome                      9.72SLE -----Duckitt K & Harrington D. BMJ. 2005 Subjects recruited 127Exclusionsmissing outcomes 3gestational HTN  5multiple gestationsa 25preeclampsia diagnosisb 12Subjects included in analyses              82 (342 samples)Excluded due to association with altered angiogenic profile:aMultiple gestations (n=20)  Maynard et al, AJOG, 2008;198:200bHypertensive diseases of pregnancy (gestational HTN & preeclampsia) Moore Simas et al, AJOG, 2007;197:244.e1-244.e8 sFlt1, PlGF and sEndoglin levels were measured by ELISA BMI & GWG adherence categories by 1990 IOM recommendationsAdherence defined by GWG and GA @ last prenatal visit subtracted from pre-pregnancy weight; thus preterm and term deliveries includedStatistical Analysis Demographic comparisons utilized Fisher exact test for categorical variables and Wilcoxonrank sum test for continuous variables  (see Table 1) Within-women correlation and right-skewness handled by estimating linear mixed models for ln-transformed biomarkers and then exponentiating on ln scale (i.e., geometric means).  Geometric mean and 95% confidence intervals displayed for sFlt1, PlGF and (sFlt1+sEng):PlGF in each of 3 gestational-age windows for UW-N vs. OW-OB BMI and Under-Appropriate vs. Over-gainers (see figures 1-6) T-test compared means in 3 windows.  Pre-pregnancy BMI CategoryPre-pregnancy BMI* (kg/m2)Total GWG at 40 weeksUnderweight (U) <19.8 28-40 lbsNormal weight  (N) 19.8-26.0 25-35 lbsOverweight (OW) 26.1-29.0 15-25 lbsObese (OB) >29.0 At least 15 lbs• Analytic sample included 82 subjects (342 specimens). See Table 1 for Demographic Comparisons.• BMI Comparisons (see Figures1–3)o Mean sFlt1 lower in all windows in OW-OB compared to U-N (Figure 1)o Mean PlGF lower in all windows in OW-OB compared to U-N (Figure 2)o Mean ratio [(sFlt1+sEng):PlGF] trended higher in OW-OB compared to U-N women at 27-30 and 31-36wks (Figure 3)• GWG Adherence Comparisons (see Figures 4–6)o Mean sFlt1 lower in all windows in OG compared to U-AG (Figure 4)o Mean PLGF lower in all windows in OG compared to U-AG (Figure 5)o Mean ratio [(sFlt1+sEng):PlGF] trended higher in OG compared to U-AG at 31-36wks (Figure 6)HypothesisTable 1. Demographic comparisons20040060080010001200140022-26 27-30 31-36SFlt1 (pg/ml)Gestational Age (Weeks)2004006008001000120022-26 27-30 31-36PlGF(pg/ml)01234522-26 27-30 31-36(SFlt1+sEng)/PlGFGestational Age (Weeks)Under-/Normal-weightOverweight/Obese1.  Geometric mean sFlt1 (95% CI)  3. Geometric mean (sFlt1+sEng)/PlGF (95% CI)  2.  Geometric mean PlGF (95% CI)  Figures 1-3.  Angiogenic biomarker profiles comparing under-/normal-weight to overweight/obese at 3 gestational age windows BMI Category(# specimen/ # women)22-26 weeks 27-30 weeks 31-36 weeksUnderweight (<19.8) 5/4 6/3 7/4Normal weight (19.8-26.0) 22/18 27/18 29/17Overweight (26.0-29.0) 22/16 23/15 28/14Obese (>29.0) 47/35 63/37 63/3620040060080010001200140022-26 27-30 31-36SFlt1 (pg/ml)Gestational Age (Weeks)200400600800100022-26 27-30 31-36PlGF(pg/ml) 0123422-26 27-30 31-36(SFlt1+sEng)/PlGFGestational Age (Weeks)Under/Appropriate-gainersOver-gainers4. Geometric mean sFlt1 (95% CI) 6. Geometric mean (sFlt1+sEng)/PlGF (95% CI) 5. Geometric mean PlGF (95% CI) GWG BMI-specific Adherence Category(# specimen/ # women)22-26 weeks 27-30 weeks 31-36 weeksUnder gainer 24/17 24/15 27/14Appropriate gainer 18/13 25/15 29/15Over gainer 54/43 70/43 71/42Figures 4-6.  Angiogenic biomarker profiles comparing under/appropriate gainers to over-gainers at 3 gestational age windows • Small sample size required collapsing of BMI and GWG-adherence categories; thus unable to look at adherence within each BMI category• Secondary analysis not powered for this exploratory analysis• Only had total GWG at end of pregnancy

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BMI, Gestational Weight Gain and Angiogenic Biomarker Profiles for Preeclampsia Risk

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