Increase of PlGF (Placental Growth Factor) Level After Administration of Dydrogesterone in Pregnancy


Aim: To observe the effect of Dydrogesterone administration in pregnancy on PlGF level

Methods: This is a randomized controlled clinical trial. Study population has been divided into two groups. Group A consists of 20 women who receive only Folic acid 5 mg a day for 4 weeks time. Group B consists of 20 women who receive Dydrogesterone 2x10 mg a day and Folic acid 5 mg a day for 4 weeks. PlGF has been measured twice. First measurement was done before drug administration, while the second measurement has been done during 18th weeks of pregnancy. The changes on PlGF level before and after treatment from each group has been analyzed using SPSS 17.

Results: 40 pregnant women have been recruited for this study. There are no differences based on the patient’s age, number of pregnancy and parity, gestational age and body weight between each group.  The mean levels of PlGF in both groups before intervention shows no significant difference (p = 0091 or p> 0.05), 40.80 pg/mL vs.  25.95 pg / mL. The mean levels of PlGF in group A after 4 weeks administration of Folic acid is 89.60 pg / mL. It shows the escalation of 48.8 pg / mL. The elevation of PlGF level in group A shows significant difference (p = 0.000 or p <0.05) after 4 weeks Folic acid treatment.The mean levels of PlGF in group B after 4 weeks administration of Dydrogesterone and Folic acid is 212.15 pg / mL. It shows the escalation of 186.20 pg / mL. The elevation of PlGF level in group B shows significant difference (p = 0.000 or p <0.05) after 4 weeks Dydrogesterone and Folic acid treatment.

Conclusion: Dydrogesterone treatment can increase the level of PlGF.

[1] W. D. Billington, The immunological problem of pregnancy: 50 Years with the hope of progress. A tribute to Peter Medawar, Journal of Reproductive Immunology, 60, no. 1, 1–11, (2003).

[2] F. G. Cunningham, et al., Williams Obstetrics. 23 ed., Mc. Graw Hill, New York, p. 47-72, 2010.

[3] R. Druckmann and M.-A. Druckmann, Progesterone and the immunology of pregnancy, Journal of Steroid Biochemistry and Molecular Biology, 97, no. 5, 389–396, (2005).

[4] J. Espinoza, R. Romero, J. K. Nien, R. Gomez, J. P. Kusanovic, L. F. Gonçalves, L. Medina, S. Edwin, S. Hassan, M. Carstens, and R. Gonzalez, Identification of patients at risk for early onset and/or severe preeclampsia with the use of uterine artery Doppler velocimetry and placental growth factor, American Journal of Obstetrics and
Gynecology, 196, no. 4, 326–e13, (2007).

[5] J. S. Hunt, D. K. Langat, R. H. McIntire, and P. J. Morales, The role of HLA-G in human pregnancy, Reproductive Biology and Endocrinology, 4, no. 1, article no. S10, (2006).

[6] R. W. Kelly, Pregnancy maintenance and parturition: The role of prostaglandin in manipulating the immune and inflammatory response, Endocrine Reviews, 15, no. 5, 684–706, (1994).

[7] G. E. Lash, K. Naruse, B. A. Innes, S. C. Robson, R. F. Searle, and J. N. Bulmer, Secretion of Angiogenic Growth Factors by Villous Cytotrophoblast and Extravillous Trophoblast in Early Human Pregnancy, Placenta, 31, no. 6, 545–548, (2010).

[8] YS. Lin and CH. Liu, Prediction of early pregnancy outcomes, Int J Gynaecol Obstet. Oct, 51, no. 1, p. 33, (1995).

[9] D. R. Mishell Jr., D. Shoupe, P. F. Brenner, M. Lacarra, J. Horenstein, P. Lahteenmaki, and I. M. Spitz, Termination of early gestation with the anti-progestin steroid RU 486: Medium versus low dose, Contraception, 35, no. 4, 307–321, (1987).

[10] E. R. Norwitz, D. J. Schust, and S. J. Fisher, Implantation and the survival of early pregnancy, New England Journal of Medicine, 345, no. 19, 1400–1408, (2001).

[11] H. Pearson, Immunity’s pregnant pause, Nature, 420, no. 6913, 265–266, (2002).

[12] N. S. Qureshi, Treatment options for threatened miscarriage, Maturitas, 65, no. 1, S35–S41, (2009).

[13] D. P. Robinson and S. L. Klein, Pregnancy and pregnancy-associated hormones alter immune responses and disease pathogenesis, Hormones and Behavior, 62, no. 3, 263–271, (2012).

[14] K. Sumapraja, Dasar-dasar Imunologi Dalam Bidang Kebidanan, in Ilmu Kebidanan Sarwono Prawirohardjo., , PT Bina Pustaka Sarwono Prawirohardjo, AB. Saifuddin, Ed., 97–111, Jakarta, 4 edition, 2010.

[15] O. Thellin, B. Coumans, W. Zorzi, A. Igout, and E. Heinen, Tolerance to the foetoplacental ’graft’: Ten ways to support a child for nine months, Current Opinion in Immunology, 12, no. 6, 731–737, (2000).