{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:53:28Z","timestamp":1792788808459,"version":"4.5.0"},"reference-count":32,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1128001"],"award-info":[{"award-number":["OPP1128001"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1196642"],"award-info":[{"award-number":["OPP1196642"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["PID2022-138243OB-I00"],"award-info":[{"award-number":["PID2022-138243OB-I00"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011033","name":"Agencia Estatal de Investigaci\u00f3n","doi-asserted-by":"publisher","award":["MCIN\/AEI\/10.13039\/501100011033\/FEDER UE"],"award-info":[{"award-number":["MCIN\/AEI\/10.13039\/501100011033\/FEDER UE"]}],"id":[{"id":"10.13039\/501100011033","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Consolidated Research Group, Departament de Recerca i Universitats, Generalitat de Catalunya","award":["2021 SGR 00881"],"award-info":[{"award-number":["2021 SGR 00881"]}],"id":[{"id":"https:\/\/ror.org\/01gbnem66","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Estimating the contribution of preeclampsia (PE) to perinatal mortality in low-resource settings remains difficult due to limited diagnostic capacity. Lack of specific histopathologic changes in stillbirth, foetuses and\/or placenta often hampers assignment of PE as cause of death. While PE angiogenic biomarkers (sFlt-1, PlGF) predict adverse pregnancy outcomes, their post-mortem diagnostic utility is unclear. We evaluated the potential role of these biomarkers in identifying PE-related perinatal deaths. This cross-sectional study was conducted among pregnant women who delivered a stillborn infant or experienced an early neonatal death at Maputo Central Hospital in Mozambique. Concentrations of sFlt-1, PlGF and their ratio (sFlt-1\/PlGF) were assessed in maternal blood and post-mortem foetal\/neonatal and placental blood. Causes of death were determined via minimally invasive tissue sampling (MITS) and diagnostic accuracy was assessed using ROC curves for standardized and optimal biomarker cut-offs. A total of 100 women with perinatal deaths (98 stillbirths and 2 early neonatal deaths) were included in the study between March 2021 and April 2022. Maternal sFlt-1\/PlGF ratios showed the highest diagnostic accuracy for PE-related deaths (area under curve [AUC]=82%), followed by placental (AUC\u2009=\u200975%) and foetal blood (AUC\u2009=\u200961%). PlGF levels were significantly reduced in PE-associated deaths. sFlt-1\/PlGF cutoffs of \u226585 and \u2265110 in maternal and placental blood were reliable cut-offs for identifying PE-related foetal\/neonatal deaths. Optimal ratio cut-offs were \u226550 (maternal blood),\u2009\u2265\u2009230 (placental blood), and \u2265140 (foetal blood), with maternal and placental sFlt-1\/PlGF ratios showing significant associations with PE-related death (OR=10.58 and 5.98 respectively). Sensitivity and specificity in maternal and placental blood were 84% and 73%, and 67% and 78%, respectively, with a positive predictive value (PPV) of 84% in both. In conclusion, maternal and placental angiogenic biomarkers enable reliable identification of preeclampsia-related perinatal deaths and could significantly enhance cause-of-death determination in low-resource, high-burden settings. These findings underscore the potential value of biomarker measurement for both risk stratification and mortality surveillance.<\/jats:p>","DOI":"10.1371\/journal.pone.0339830","type":"journal-article","created":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T17:30:29Z","timestamp":1792085429000},"page":"e0339830","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["The value of angiogenic biomarkers in determining preeclampsia-related perinatal deaths: A cross-sectional study in a high burden setting of southern Mozambique"],"prefix":"10.1371","volume":"21","author":[{"given":"Maureen N.","family":"Chileshe","sequence":"first","affiliation":[{"name":"ISGlobal","place":["Barcelona, Spain"]},{"name":"Facultat de Medicina i Ci\u00e8ncies de la Salut, Universitat de Barcelona","place":["Barcelona, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5030-3526","authenticated-orcid":true,"given":"Natalia","family":"Rakislova","sequence":"additional","affiliation":[{"name":"ISGlobal","place":["Barcelona, Spain"]},{"name":"Facultat de Medicina i Ci\u00e8ncies de la Salut, Universitat de Barcelona","place":["Barcelona, Spain"]},{"name":"Hospital Cl\u00ednic de Barcelona","place":["Barcelona, Spain"],"department":["Department of Pathology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla","family":"Carrilho","sequence":"additional","affiliation":[{"name":"Eduardo Mondlane University","place":["Maputo, Mozambique"],"department":["Faculty of Medicine"]},{"name":"Maputo Central Hospital","place":["Maputo, Mozambique"],"department":["Department of Pathology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabiola","family":"Fernandes","sequence":"additional","affiliation":[{"name":"Eduardo Mondlane 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Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N\u00faria","family":"Pe\u00f1uelas","sequence":"additional","affiliation":[{"name":"ISGlobal","place":["Barcelona, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anete","family":"Mendes","sequence":"additional","affiliation":[{"name":"Manhi\u00e7a Health Research Center","place":["Manhi\u00e7a, Mozambique"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elvira","family":"Luis","sequence":"additional","affiliation":[{"name":"Maputo Central Hospital","place":["Maputo, Mozambique"],"department":["Obstetrics and Gynecology Department"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1059-217X","authenticated-orcid":true,"given":"Jahit","family":"Sacarlal","sequence":"additional","affiliation":[{"name":"Eduardo Mondlane University","place":["Maputo, Mozambique"],"department":["Faculty of 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