A growing body of evidence supports assessment of maternal serum PlGF levels in identification of potential adverse outcomes of pregnancy. In the first trimester, PlGF is used as a biomarker in a multivariate screening algorithm for prediction of early onset pre-eclampsia (ePE). This algorithm, validated in a diverse range of populations worldwide, predicts more than 90% of women who will go on to develop ePE. Coupled with a cheap prophylactic intervention (prescription of aspirin to high risk women), more than 80% of early onset disease. A cost economic analysis shows that investment in screening dominates costs of neonatal care avoided through later gestation of delivery.
PlGF can be used in the third trimester, either alone or in combination with sFlt, to predict whether hypertensive women have pre-eclampsia rather than more benign gestational hypertension, to triage hospital admission and predict severity of disease and need for imminent delivery. The negative predictive value can be used in low risk (non-hypertensive) populations to reduce frequency of clinic visits. Further work is needed to define the role of PlGF in screening for fetal growth restriction and to identify the best way to adopt this marker in alternative approaches to screening for aneuploidy.