Predictive Performance of First-Trimester Serum PlGF and sFlt-1 Matrix for Gestational Hypertension Stratification

International Journal of Obstetrics and Gynecology | Vol. 14, No. 8, August 2026 | pp. 459–470

DOI: 10.46882/2026/IJOG/000519

Original Research Article

Title: Predictive Performance of First-Trimester Serum PlGF and sFlt-1 Matrix for Gestational Hypertension Stratification

Names of Authors: Fatima B. Aliyu¹, Tunde M. Bakare¹

Authors’ Affiliations:
¹ Department of Obstetrics and Gynecology, Aminu Kano Teaching Hospital, Kano, Nigeria

Abstract:
Early tracking of women prone to gestational hypertensive disorders allows for targeted preventative surveillance. This prospective cohort study assessed the diagnostic accuracy of first-trimester serum soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) concentrations in predicting the subsequent development of gestational hypertension. A total of 550 asymptomatic nulliparous women were screened between 11 and 13⁺⁶ weeks of gestation. Serum biomarker levels were quantified via automated immunoassays and converted to Multiples of the Median (MoM). Patients were tracked dynamically until delivery, and the primary endpoint was the development of de novo hypertension after 20 weeks. Fifty-two women (9.5%) developed gestational hypertension. Women who developed the condition exhibited significantly lower median PlGF levels (0.64 MoM vs. 1.02 MoM, p < 0.001) and elevated sFlt-1/PlGF ratios (48.4 ± 12.2 vs. 22.5 ± 6.8, p < 0.001) in the first trimester compared to those who remained normotensive. A multivariable predictive risk index incorporating maternal mean arterial pressure (MAP), uterine artery pulsatility index, and the sFlt-1/PlGF ratio demonstrated a diagnostic sensitivity of 82.7%, a specificity of 86.3%, and an Area Under the Curve (AUC) of 0.91. First-trimester screening utilizing maternal serum angiogenic biomarkers linked with clinical blood pressure measurements provides an exceptional, highly reproducible risk matrix to identify women likely to experience gestational hypertension long before clinical signs manifest.

Keywords: Gestational Hypertension; Placental Growth Factor; sFlt-1; First-Trimester Screening; Angiogenic Biomarkers; Risk Stratification.

Manuscript Timeline: Received: May 22, 2026; Revised: July 10, 2026; Accepted: July 28, 2026; Published: August 14, 2026.

Citation: Aliyu FB, Bakare TM. Predictive Performance of First-Trimester Serum PlGF and sFlt-1 Matrix for Gestational Hypertension Stratification. International Journal of Obstetrics and Gynecology. 2026; 14(8): 459–470.

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