Predictive Accuracy of Mid-Trimester Serum Soluble Endoglin and Placental Growth Factor Ratio for Late-Onset Preeclampsia

International Journal of Obstetrics and Gynecology | Vol. 14, No. 9, September 2026 | pp. 1011–1022

DOI: 10.46882/2026/IJOG/000565

Original Research Article

Title: Predictive Accuracy of Mid-Trimester Serum Soluble Endoglin and Placental Growth Factor Ratio for Late-Onset Preeclampsia

Names of Authors: Olivia Taylor¹, Marie Dupont²

Authors’ Affiliations:
¹ Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
² Service de Gynécologie-Obstétrique, Hôpital de la Conception, Marseille, France

Abstract:
Late-onset preeclampsia (developing at or after 34 weeks of gestation) presents unpredictable clinical courses, requiring robust biomarkers to optimize screening and management pathways. This prospective cohort study assessed the diagnostic performance of the mid-trimester serum soluble endoglin to placental growth factor (sEng/PlGF) ratio in predicting the subsequent development of late-onset preeclampsia. Serum samples were collected from 500 asymptomatic nulliparous women between 20 and 24 weeks of gestation during routine anatomical ultrasound scans. Biomarker levels were quantified via automated immunoassays. All participants were followed longitudinally until delivery, and 48 cases (9.6%) were complicated by late-onset preeclampsia. Women who subsequently developed the condition demonstrated significantly elevated sEng concentrations and decreased PlGF levels at mid-gestation, resulting in an elevated sEng/PlGF ratio compared to normotensive controls (42.4 ± 10.5 vs. 18.5 ± 5.2, p < 0.001). A multivariable predictive risk index incorporating maternal mean arterial pressure (MAP), uterine artery pulsatility index, and the sEng/PlGF ratio achieved an excellent diagnostic performance, yielding a sensitivity of 85.4%, a specificity of 89.2%, and an Area Under the Curve (AUC) of 0.92 for late-onset preeclampsia prediction. Mid-trimester screening utilizing maternal serum angiogenic biomarkers combined with clinical blood pressure indices provides an objective, highly reproducible risk matrix to identify women likely to experience late-onset preeclampsia long before clinical manifestations emerge.

Keywords: Late-Onset Preeclampsia; Soluble Endoglin; Placental Growth Factor; Angiogenic Biomarkers; Mid-Trimester Screening; Risk Stratification.

Manuscript Timeline: Received: July 02, 2026; Revised: August 28, 2026; Accepted: September 14, 2026; Published: September 24, 2026.

Citation: Taylor O, Dupont M. Predictive Accuracy of Mid-Trimester Serum Soluble Endoglin and Placental Growth Factor Ratio for Late-Onset Preeclampsia. International Journal of Obstetrics and Gynecology. 2026; 14(9): 1011–1022.

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