Markers for Presymptomatic Prediction of Preeclampsia and Intrauterine Growth Restriction

Abstract

Preeclampsia and intrauterine growth restriction are both characterized by placental malfunction. The pathological processes of abnormal trophoblast invasion, partial absence of maternal spiral artery modification, increased apoptosis of trophoblast cells, and placental ischemia are all associated with the release of specific molecules. These proteins, as well as cell-free fetal DNA and RNA might be detected in the maternal peripheral circulation, quantified, and used for early identification and prediction of preeclampsia and intrauterine growth restriction, prior to the appearance of the clinical symptoms. As preeclampsia and intrauterine growth restriction are associated with increased maternal, perinatal, and neonatal morbidity and mortality, early identification of these pregnancy associated complications will permit the design of appropriate preventive measures. In this review a variety of factors reported to be useful as potential markers for early detection of pregnancies at increased risk will be discussed. Molecules associated with the establishment of the placenta and essential in fetal-maternal interactions, like interleukin 2-receptor, insulinlike growth factor-1, and insulinlike growth factor binding protein-1, placenta growth factor, hepatocyte growth factor, inhibin A, activin A, and human chorionic gonadotrophin seem to be the most likely candidates for presymptomatic markers for preeclampsia and/or intrauterine growth restriction. Detection and discrimination of these molecules through the placental RNA in maternal plasma based strategy has become a realistic option.

Fibronectin, Plasminogen Activator Inhibitor Type 1 (PAI-1) And Uterine Artery Doppler Velocimetry as Markers of Preeclampsia

“…The authors concluded that total fibronectin might be useful to determine relative risks, but is a poor predictor in a low risk population. Tjoa et al repeated this plasma analysis of total fibronectin in a similar low risk population, with emphasis on the first trimester and found no differences in plasma total fibronectin levels in pregnant women between 7th-20th gw [1]. Ostlund et al showed relation of plasma total fibronectin to blood pressure in women who developed preeclampsia in 16 gw and even higher in those with laboratory signs of organ involvement [7].…”

“…It is characterized by maternal hypertension, proteinuria, edema, potentially causing fetal growth restriction and premature delivery [1]. This common pregnancy-associated disease is a leading cause of perinatal morbidity and mortality of mother and child [2].…”

Expression of Inhibin/activin Subunits alpha (-α), beta A (-β A) and beta B (-β B) in Placental Tissue of Normal and Intrauterine Growth Restricted (IUGR) Pregnancies

“…In preeclampsia and idiopathic small for gestational age (SGA) pregnancies, cytotrophoblast invasion is restricted with a limited remodelling of spiral arteries, thus resulting in reduced uteroplacental perfusion (Lim et al 1997). Small fetuses due of intrauterine growth restriction (IUGR) are at higher risk for poor perinatal and long-term outcome (Baschat 2004;Tjoa et al 2004), being associated with an increased risk of heart diseases and type 2 diabetes mellitus (Barker 1998). The most common definition of IUGR is a birth weight lower than the 10th percentile when adjusted to gestational age.…”

Expression of lipocalin-type prostaglandin D synthase in preeclampsia patients: a novel marker for preeclampsia

“…Unfortunately, a reliable biomarker has yet to be identified. [5][6][7][8] A novel biomarker of vascular epithelium disorders is lipocalintype prostaglandin D synthase (L-PGDS). Accordingly we measured urine and blood L-PGDS concentrations in preeclamptic patients and normal pregnancy women and determined whether L-PGDS is a potential biomarker of preeclampsia or not.…”