Decoding Pregnancy Risks: How Arterial Stiffness and Placental Growth Factor Impact Outcomes
"New research sheds light on predicting adverse pregnancy outcomes in women with chronic hypertension by assessing arterial stiffness and placental growth factor."
Chronic hypertension during pregnancy presents 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 interventions that can improve both maternal and fetal health. Recent research has focused on identifying biomarkers that can predict these complications before they arise.
A study presented at the American Journal of Obstetrics & Gynecology explored the potential of arterial stiffness, measured by pulse wave velocity (PWV), 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 who would develop early placental disease, requiring delivery before 34 weeks of gestation.
By understanding how these biomarkers correlate with pregnancy outcomes, healthcare providers can better stratify risk, implement targeted interventions, and ultimately improve the health trajectories for both mother and child. This article delves into the findings of this study, offering insights into the implications for prenatal care and future research.
The Growing Burden of Hypertension in Pregnancy
Hypertensive disorders in pregnancy include chronic hypertension, chronic hypertension with superimposed preeclampsia, gestational hypertension, preeclampsia, and eclampsia. The CDC identifies these conditions as common pregnancy complications and among the leading causes of maternal morbidity and mortality in the United States. U.S. birth certificate data indicate that hypertension in pregnancy prevalence doubled over the last three decades, while an NIH-supported study of nearly 2 million pregnancies found that chronic hypertension prevalence doubled from 2007 to 2021 and that only about 60% of affected patients received antihypertensive medication.
Pregnancy Hypertension as a Lifelong Risk Marker
Research has established that complications during pregnancy may contribute to later maternal hypertension and cardiovascular risk. Chronic hypertension in pregnancy has been associated with adverse outcomes including preeclampsia, cesarean delivery, cerebrovascular accidents, fetal growth restriction, preterm birth, and maternal and perinatal death. Hypertensive disorders occur in 8–10% of pregnancies in the United Kingdom and remain a significant cause of maternal and fetal morbidity and mortality.
Arterial Stiffness and Placental Growth Factor: Key Predictors?
The prospective cohort study included 503 women with a diagnosis of hypertension before pregnancy or before 20 weeks of gestation, and/or a history of preeclampsia before 34 weeks, in a previous pregnancy. Researchers measured pulse wave velocity (PWV), an indicator of arterial stiffness, and placental growth factor (PlGF) longitudinally. The primary outcome was placental disease requiring delivery before 34 weeks of gestation due to preeclampsia, with or without fetal growth restriction (FGR). All participants were prescribed aspirin as a preventive measure.
- Elevated Pulse Wave Velocity (PWV): Higher PWV values indicate stiffer arteries, which can impair blood flow to the placenta.
- Reduced Placental Growth Factor (PlGF): Lower PlGF levels suggest compromised placental development and function.
- Impact of Prior Complications: Previous complicated pregnancies can modify these biomarker patterns.
- Early Prediction: Measuring PWV and PlGF early in pregnancy can provide insights into potential complications.
Refining Diagnosis and Treatment
Recent work spans both diagnostic testing and treatment of hypertension in pregnancy. NICE guidance addresses placental growth factor-based testing to help diagnose suspected preterm preeclampsia, while newer reviews examine emerging randomized clinical trials, systematic reviews, meta-analyses, and updated international recommendations for chronic hypertension. Across recent clinical reviews, early identification, blood pressure control, monitoring for maternal-fetal deterioration, and coordinated care remain central themes.
Uncertainty About Repeat PLGF Testing
PLGF-based testing can support assessment when preterm preeclampsia is suspected, but important evidence gaps remain. NICE reports that there is not enough evidence to determine whether the test should be repeated. Consequently, NICE recommends testing once when a person presents with possible symptoms of preterm preeclampsia during an episode and calls for further research into whether repeat testing improves outcomes.
Different Hypertension Profiles in Pregnancy
Pregnancy-induced hypertension and chronic hypertension should not be treated as interchangeable conditions. A 2026 review explicitly differentiates their effects on maternal and fetal health and examines their distinctive risk profiles, diagnostic markers, and clinical outcomes. The review presents this comparison as an effort to address a gap in the existing evidence base.
Implications for Future Pregnancy Care
The study underscores the importance of assessing arterial stiffness and placental growth factor in hypertensive women during early pregnancy. These measurements can help identify women at higher risk of developing early placental disease, allowing for more intensive monitoring and potential interventions. While the sensitivity and positive predictive value are not perfect, incorporating these biomarkers into clinical practice can refine risk stratification and improve outcomes.
The Scale of Hypertensive Disorders
A 2026 systematic review estimates that hypertensive disorders of pregnancy complicate about 10% of pregnancies. Its reported distribution is approximately 1% to 2% for chronic hypertension, 5% to 6% for gestational hypertension, and 2% to 4% for preeclampsia. The review also describes HDP prevalence as rising modestly over time, likely in connection with changing maternal characteristics.
Long-Term Cardiovascular Prevention
Future priorities include addressing the increasing prevalence of chronic hypertension and obesity among women of reproductive age. Hypertensive disorders of pregnancy affect 5–10% of pregnancies according to a 2024 review and are associated with cardiovascular morbidity and mortality later in life. U.S. data also show that hypertension in pregnancy prevalence doubled over the last three decades, underscoring the need for continued prevention, recognition, and long-term follow-up.
Serious Complications in Real-World Care
Hypertensive disorders of pregnancy affect approximately 10%–15% of pregnancies worldwide and can cause maternal and neonatal morbidity and mortality. Chronic hypertension complicates 1% to 2% of pregnancies and can substantially increase maternal and fetal morbidity. A case-based review describes severe chronic hypertension requiring five antihypertensive agents and ending in preterm delivery for fetal compromise, while another clinical source notes that consensus supports treatment of severe hypertension at systolic blood pressure of at least 160 mmHg or diastolic blood pressure of 105–110 mmHg.