Surreal illustration of a pregnant woman surrounded by swirling arteries and a glowing placenta, symbolizing the interplay between maternal cardiovascular health and fetal development.

Decoding Hypertension in Pregnancy: Can Arterial Stiffness and Placental Growth Predict Outcomes?

Soraya Malik in Health & Wellness December 2025 • 4 min read.

"New research explores how arterial stiffness and placental growth factors may predict adverse pregnancy outcomes in women with chronic hypertension, potentially improving risk stratification and future interventions."

Chronic hypertension during pregnancy poses significant risks, often leading to adverse outcomes such as preeclampsia, fetal growth restriction, and preterm birth. Identifying women at high risk early in pregnancy is crucial for timely intervention and improved maternal and fetal health. Traditional methods of risk assessment often fall short, prompting researchers to explore novel biomarkers and diagnostic tools.

A recent study published in the American Journal of Obstetrics & Gynecology investigated the potential of arterial stiffness and placental growth factor (PlGF) as independent predictors of adverse pregnancy outcomes in women with chronic hypertension. The study aimed to determine whether these factors could help identify women at higher risk for early placental disease and other complications.

The prospective cohort study, conducted between 2012 and 2017, recruited 503 women with a diagnosis of hypertension made before pregnancy or before 20 weeks gestation, and/or a history of preeclampsia. Researchers measured pulse wave velocity (PWV), a measure of arterial stiffness, and PlGF, a protein essential for placental development, throughout the pregnancy.

How Arterial Stiffness and Placental Growth Impact Pregnancy Outcomes

Surreal illustration of a pregnant woman surrounded by swirling arteries and a glowing placenta, symbolizing the interplay between maternal cardiovascular health and fetal development.

The study's results indicated that women who developed early placental disease, defined as requiring delivery before 34 weeks due to preeclampsia, exhibited significantly elevated PWV and lower PlGF levels throughout gestation. These findings suggest that increased arterial stiffness and impaired placental development, as reflected by reduced PlGF, are associated with adverse pregnancy outcomes in women with chronic hypertension.

Specifically, the research highlighted several key findings:

Elevated PWV: Women with early placental disease had higher pulse wave velocity, indicating stiffer arteries, which can impair blood flow to the placenta.
Reduced PlGF: Lower levels of placental growth factor suggested compromised placental development and function.
Prior Pregnancy Impact: In women with a history of complicated pregnancies, early pregnancy PWV was not as elevated, but PlGF levels were still significantly lower, indicating that prior pregnancy history can modify these biomarkers.
Predictive Power: Combining PWV and PlGF measurements in early pregnancy demonstrated a modest sensitivity (77%) for predicting early placental disease, with a positive predictive value of 24%.

These results emphasize the importance of assessing arterial stiffness and placental growth in hypertensive women during early pregnancy to identify those at highest risk for complications. The study's findings suggest that these metrics could provide valuable insights into placental function and cardiovascular health, enabling more targeted interventions.

Future Implications and Early Intervention

The study underscores the potential of arterial stiffness and placental growth factor as valuable tools for risk stratification in pregnant women with chronic hypertension. By identifying women at higher risk for early placental disease, healthcare providers can implement targeted interventions, such as intensified monitoring, medication adjustments, and lifestyle modifications, to improve pregnancy outcomes.

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Everything You Need To Know

What is the significance of arterial stiffness, measured by Pulse Wave Velocity (PWV), in predicting adverse pregnancy outcomes for women with chronic hypertension?

Arterial stiffness, measured by Pulse Wave Velocity (PWV), plays a crucial role in predicting adverse pregnancy outcomes in women with chronic hypertension. The research indicates that women who developed early placental disease had higher PWV, signifying stiffer arteries. This stiffness can impede blood flow to the placenta, thereby potentially causing complications such as preeclampsia, fetal growth restriction, and preterm birth. Elevated PWV in early pregnancy is therefore indicative of increased risk, providing a valuable biomarker for risk stratification and the potential for early intervention.

How does Placental Growth Factor (PlGF) relate to pregnancy outcomes, and what does its reduced level signify in the context of chronic hypertension?

Placental Growth Factor (PlGF) is a critical protein for placental development and function. Reduced levels of PlGF during pregnancy, particularly in women with chronic hypertension, are strongly associated with compromised placental development and function. The study showed that women who experienced adverse pregnancy outcomes had lower PlGF levels. This reduction suggests that the placenta may not be developing or functioning optimally, which can lead to complications such as preeclampsia and fetal growth restriction. Therefore, assessing PlGF levels can help identify women at higher risk, enabling timely interventions to improve pregnancy outcomes.

Can the combined use of PWV and PlGF measurements improve the prediction of early placental disease in women with chronic hypertension? What are the limitations?

The combined use of Pulse Wave Velocity (PWV) and Placental Growth Factor (PlGF) measurements shows promise in predicting early placental disease in women with chronic hypertension. The research found that combining both metrics in early pregnancy had a modest sensitivity (77%) for predicting early placental disease. However, the positive predictive value was 24%, indicating that while the test can identify many at-risk women, a significant number of women identified as high-risk may not develop complications. This highlights a limitation where further refinement of the predictive model, potentially including additional biomarkers or clinical factors, may be needed to increase accuracy and reduce false positives.

How does a prior history of complicated pregnancies impact the relationship between PWV and PlGF in women with chronic hypertension?

A history of complicated pregnancies can modify the relationship between Pulse Wave Velocity (PWV) and Placental Growth Factor (PlGF) in women with chronic hypertension. The research noted that, in women with a history of complicated pregnancies, early pregnancy PWV was not as elevated as in women without such a history. However, PlGF levels were still significantly lower, suggesting that prior pregnancy complications can influence the biomarkers. This indicates that while arterial stiffness might not be as pronounced in early pregnancy for these women, compromised placental development, as reflected by reduced PlGF, remains a key indicator of risk. This highlights the importance of considering individual patient history in risk assessment.

What interventions can be considered based on findings related to arterial stiffness and PlGF in pregnant women with chronic hypertension?

Based on the findings related to arterial stiffness (PWV) and Placental Growth Factor (PlGF), healthcare providers can implement targeted interventions to improve pregnancy outcomes in women with chronic hypertension. These interventions may include intensified monitoring to closely observe the pregnancy's progress, medication adjustments to better manage the hypertension and reduce the risk of complications, and lifestyle modifications such as dietary changes and increased physical activity. The goal is to mitigate risks associated with adverse outcomes, potentially reducing preeclampsia, fetal growth restriction, and preterm birth, thereby improving both maternal and fetal health.