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Poster Session 4

Category: Hypertension

Poster Session 4

(1286) Unmasking Risk in Low/Intermediate sFlt-1/PlGF Ratios with a Novel Angiogenic Classification

Thursday, February 12, 2026

3:30 PM - 5:00 PM

Submitting Author and Presenting Author(s)

Valentina Giardini, MD

Department of Obstetrics, IRCCS San Gerardo dei Tintori Foundation
Monza, Lombardia, Italy

Coauthor(s)

CZ

Caterina Zavettieri, MD

University of Milano-Bicocca
Milan, Lombardia, Italy
AT

Alessandra Terzaghi, MD

University of Milano-Bicocca
Milan, Lombardia, Italy
AP

Arianna Pelucchi, MD

University of Milano-Bicocca
Milan, Lombardia, Italy
IR

Ilaria Re, MD

University of Milano-Bicocca
Milan, Lombardia, Italy
LG

Leonora Grilli, MD

University of Milano-Bicocca
Milan, Lombardia, Italy
MC

Marco Casati, MD

Laboratory Medicine, IRCCS San Gerardo dei Tintori Foundation
Monza, Lombardia, Italy
Anna Locatelli, MD (she/her/hers)

School of Medicine and Surgery, University of Milano-Bicocca
Milan, Lombardia, Italy

Objective:
Soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF), expressed as the sFlt-1/PlGF ratio, are widely used for the assessment of placental dysfunction. We aimed to challenge the clinical safety and accuracy of the low and intermediate ratio categories by exploring whether a novel classification based on absolute sFlt-1 and PlGF levels better improves risk stratification in women with suspected hypertensive disorders (HD) or fetal growth restriction (FGR).

Study Design:
Retrospective analysis of hospitalized singleton pregnancies beyond 20 weeks complicated by HD, FGR, or both, with low (< 38) or intermediate sFlt-1/PlGF ratios (38–85, or 38–110 if ≥34 weeks) from 2018 to 2022. Pregnancies affected by COVID-19 or fetal chromosomal abnormalities were excluded. Angiogenic markers were measured using automated assays - Roche. Each patient was classified into one of nine angiogenic groups, based on whether sFlt-1 and PlGF values were above, within, or below gestational age-specific reference ranges (10th–90th percentile). Obstetric outcomes were compared across groups.

Results:
Of the 242 women included, 52% had a low sFlt-1/PlGF and 48% an intermediate ratio. Based on absolute biomarker values (Table 1), 59% had both markers in range (Category 1); of these, 34% had an intermediate ratio. In contrast, 36% showed abnormal values in Categories 3-4-6, including 13% with a low ratio. Compared to Category 1, the combined abnormal marker group had significantly higher rates of adverse outcomes: severe preeclampsia, medically indicated preterm birth, and urgent cesarean sections (all p< 0.01 – Table 2). Category 6 had the worst profile, with mean gestational age at delivery of 35+4 weeks and the highest incidence of FGR, small-for-gestational-age neonates, and severe hypertensive complications (all p< 0.01).

Conclusion:

A dual-marker approach uncovers hidden risk within low and intermediate ratio groups, enabling better risk stratification, personalized surveillance, and reduction of unnecessary interventions.