• Ioakeim Sapantzoglou, Angeliki Rouvali, Antonios Koutras, Maria Ioanna Chatziioannou, Ioannis Prokopakis, Zacharias Fasoulakis, Eleftherios Zachariou, Athanasios Douligeris, Anastasia Mortaki, Paraskevas Perros, Thomas Ntounis, Vasilios Pergialiotis, Ekaterini Domali, Stavros Athanasiou, George Daskalakis, Alexandros Rodolakis, Periklis Panagopoulos, and Kalliopi I Pappa.
• 1st Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece.
• Medicina (Kaunas). 2023 Jun 30; 59 (7).

AbstractTwin pregnancies demonstrate a 2-3-fold higher chance of developing PE compared to singletons, and recent evidence has demonstrated that the sFLT1/PIGF ratio is strongly associated with PE, adverse pregnancy outcomes, as well as imminent deliveries due to PE complications. The primary objective of this systematic review was to summarise the available data on the levels of sFLT1, PlGF and their ratios in twin pregnancies and to investigate their association with the development of PE, adverse pregnancy outcomes and the timing of the delivery. A systematic search of Ovid Embase, Web of Science, Science Direct, PubMed, Ovid Medline, Google Scholar and CINAHL was carried out. sFLT1 levels and the sFLT1/PIGF ratio appeared higher in twins compared to singleton pregnancies, especially in the third trimester, while PlGF levels appeared higher up until the third trimester, with their values showing no difference or being even lower than in singletons thereafter. The sFLT1/PIGF ratio has been reported to be an independent marker of adverse outcomes related to pre-eclampsia and is associated with the mean time until delivery in an inverse manner. Further research is required in order to establish the optimal sFLT1/PIGF cut-off values and to stratify the risk of adverse outcomes in twin pregnancies.

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