Real life outpatient biomarker use in management of hypertensive pregnancies in third trimester in a low resource SeTting: ROBUST study

Pregnancy Hypertens. 2021 Mar:23:97-103. doi: 10.1016/j.preghy.2020.11.010. Epub 2020 Dec 3.


Objectives: The utility of angiogenic biomarkers in a low resource outpatient setting is not well known. This study evaluates the clinical utility of angiogenic biomarkers, soluble fms-like tyrosine kinase 1 (sFlt1) and placental growth factor (PlGF) among patients at risk for preeclampsia in a low resource outpatient setting.

Study design: This was a prospective pilot study among high risk third trimester outpatients conducted in Bengaluru, India. Serum sFlt1/PlGF was measured between 28 and 37 weeks. Patients with high risk ratio were managed with close observation, intermediate risk had serum redrawn in one week, and those with low risk ratio received routine care. Delivery decisions were made based on local protocols.

Main outcome measures: Maternal complication rate, development of preeclampsia with severe features, and latency to delivery was examined by sFlt1/PlGF ratio.

Results: The study included 50 patients. Compared to women with a low risk ratio, women with a high-risk ratio were more likely to have preeclampsia with severe features (90.91% vs 8.00%, p < 0.0001), a higher composite maternal complication rate (18.18% vs 0%, p = 0.04) and deliver at earlier gestational ages (32.57 [30.43, 34.71] vs 37.43 [36.86, 38.14] weeks, p = 0.0001).

Conclusion: Angiogenic factors may have utility in the low resource outpatient setting for women with a hypertensive disease. Low sFlt1/PlGF levels were associated with a longer latency to delivery and no maternal complications. This study confirms the broad clinical utility of biomarkers in the real world.

Keywords: Angiogenic biomarker; Preeclampsia; Prenatal care; Risk assessment.

MeSH terms

  • Adult
  • Biomarkers / blood
  • Female
  • Humans
  • India
  • Odds Ratio
  • Pilot Projects
  • Placenta Growth Factor / blood*
  • Poverty
  • Pre-Eclampsia / blood
  • Pre-Eclampsia / diagnosis*
  • Pregnancy
  • Pregnancy Trimester, Third
  • Prenatal Care / methods
  • Prospective Studies
  • Vascular Endothelial Growth Factor Receptor-1 / blood*


  • Biomarkers
  • PGF protein, human
  • Placenta Growth Factor
  • Vascular Endothelial Growth Factor Receptor-1