To assess in women with early-onset severe preeclampsia whether longitudinal changes in angiogenic factors improve the prediction of adverse outcome.
Prospective cohort study.
Maternity units in two Spanish hospitals.
Women with diagnosis of early-onset severe preeclampsia.
Levels of placental growth factor [PlGF], soluble fms-like tyrosine kinase [sFlt-1] and sFlt-1/PlGF ratio were measured at admission and before delivery; and average daily change was calculated. The association of longitudinal changes of angiogenic factors with the time interval to delivery and with complications was evaluated by logistic and Cox regression.
Interval to delivery and composite of adverse outcomes.
We included 63 women, of which 26 (41.3%) had a complication. Longitudinal changes of sFlt-1 were more pronounced in complicated pregnancies (median: 1047 vs. 342 pg/mL/day; p=0.04). On the multivariate analysis, the clinical risk score and sFlt-1 at admission explained 6.2% of the uncertainty for complication, the addition of sFlt-1 longitudinal changes improved this to 25.3% (p=0.002). The median time from admission to delivery was 4 days (95% CI 1.6-6.04) in those in the highest quartile of sFlt-1 longitudinal changes vs. 16 days (95% CI 12.4-19.6) in the remaining women (Log-rank test p<0.001).
Longitudinal changes in sFlt-1 maternal levels from admission for confirmed early-onset severe preeclampsia add to baseline characteristics in the prediction of adverse outcome and interval to delivery.

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