Avaliação da concentração sérica do fator de crescimento placentário (PlGF) nas gestantes diagnosticadas com pré-eclâmpsia: uma revisão sistemática

Abstract

Preeclampsia is a hypertensive complication of pregnancy that affects between 2% and 8% of pregnant women and is one of the leading causes of maternal and fetal morbidity and mortality. Its etiology is multifactorial and is characterized by the presence of arterial hypertension, proteinuria, thrombocytopenia, impaired liver function, renal insufficiency, and other clinical manifestations. Placental growth factor (PlGF) is essential for placental angiogenesis and serves as a biomarker for early diagnosis and risk assessment of preeclampsia. Given this, the objective of this research was to characterize the clinical-epidemiological profile of pregnant women diagnosed with preeclampsia and to evaluate the variation in the mean serum PlGF concentration with the progression of gestational trimesters. To achieve these objectives, a systematic review was conducted following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The review question was formulated using the PECOS acronym (Population, Exposure, Comparator, Outcome, and Study) as follows: "In pregnant women with preeclampsia, is the effectiveness of placental growth factor (PlGF) as a biomarker variable across gestational trimesters?" The databases used were PubMed and Embase, utilizing the DeCS and MeSH platforms for descriptor selection. Observational case-control studies evaluating PlGF concentrations in pregnant women with preeclampsia were included, with no language or publication year restrictions. Initially, 246 studies were identified; after duplicate removal and application of inclusion and exclusion criteria, 19 articles were included for analysis. The period from 2001 to 2007 had the highest number of publications, primarily from the United States. The mean serum PlGF concentration in the pregnant women included in the studies was 238 pg/mL, with serum levels below normal (12–99 pg/mL) in seven evaluated studies. The lowest PlGF concentrations were observed in the first (77 pg/mL) and third (101 pg/mL) trimesters. The same pattern was observed in severe preeclampsia (129 pg/mL), early-onset cases (69 pg/mL), and preterm cases (143 pg/mL). Preeclampsia was more prevalent among non-white women under 35 years old, with a high BMI, and among nulliparous and primiparous women. PlGF concentrations varied according to the severity and gestational period, being lower in early-onset and severe cases of the disease. Thus, it was possible to verify that serum levels of this factor vary according to the clinical presentation of the disease, maternal characteristics such as pre-existing conditions (e.g., chronic hypertension, diabetes), obstetric and family history (parity, previous preeclampsia, and multiple pregnancies), and sociodemographic characteristics (advanced maternal age and ethnicity). Furthermore, these findings highlight the relevance and effectiveness of PlGF as a tool for risk stratification of preeclampsia, especially when combined with clinical and sociodemographic variables, enabling more targeted interventions in prenatal care.