Maternal Serum Placental Growth Factor, Pregnancy-Associated Plasma Protein-A and Free β-Human Chorionic Gonadotrophin at 30-33 Weeks in the Prediction of Pre-Eclampsia

Abstract

Objective: To investigate the potential value of maternal serum concentrations of free β-human chorionic gonadotrophin (β-hCG), pregnancy-associated plasma protein-A (PAPP-A) and placental growth factor (PlGF) at 30-33 weeks of gestation in the prediction of pre-eclampsia (PE) developing at or after 34 weeks. Methods: Serum free β-hCG, PAPP-A and PlGF were measured at 11-13 and at 30-33 weeks of gestation in a case-control study of 50 cases that developed PE at or after 34 weeks and 250 unaffected controls. The measured concentration of metabolites was converted into multiples of the unaffected median (MoM) and the MoM values in the PE and control groups were compared. Results: At 11-13 weeks, serum PlGF and PAPP-A, but not free β-hCG, were significantly lower in the PE group than in the controls (0.824, 0.748 and 0.857 vs. 1.000 MoM). At 30-33 weeks in the PE group, PlGF was reduced (0.356 MoM), free β-hCG was increased (1.750 MoM), but PAPP-A was not significantly different (0.991 MoM) from control (1.000 MoM). In screening for PE at 30-33 weeks by a combination of maternal characteristics and serum PlGF, the estimated detection rates, at a false-positive rate of 10%, of intermediate PE (requiring delivery at 34-37 weeks) and late PE (with delivery after 37 weeks) were 85.7 and 52.8%, respectively. The performance of screening was not improved by the addition of free β-hCG or the free β-hCG/PlGF ratio. Conclusion: Screening by maternal characteristics and serum PlGF at 30-33 weeks could identify most pregnancies that will subsequently develop PE.

Serum placental growth factor in late first trimester of pregnancy for prediction of preeclampsia in primigravida - a case control study

“…6 In another study by Lai et al, median PLGF level in all PE cases and late PE cases was significantly lower compared to controls with PLGF level as 25.1, 27.2 and 34.7 pg/ml respectively. 2 The Poon et al study with base-cohort population of 7797 singleton pregnancies, including 34 case subjects also had similar findings.…”

“…3 Various other studies comparing the role of PLGF versus other biochemical markers have been done using AUC. 2,10 In these studies PLGF has emerged as of best predictive value with maximum AUC for prediction of PE. 2 In one of the pioneer studies involving large number (n=5,099) of pregnant females where 145 developed PE (2.84%), Lai et al found AUC of 0.734 for late PE cases.…”

“…2,10 In these studies PLGF has emerged as of best predictive value with maximum AUC for prediction of PE. 2 In one of the pioneer studies involving large number (n=5,099) of pregnant females where 145 developed PE (2.84%), Lai et al found AUC of 0.734 for late PE cases. 2 Similarly, Youssef et al found that for PLGF, AUC was 0.703 (0.502-0.904) for late PE cases.…”

“…2 In one of the pioneer studies involving large number (n=5,099) of pregnant females where 145 developed PE (2.84%), Lai et al found AUC of 0.734 for late PE cases. 2 Similarly, Youssef et al found that for PLGF, AUC was 0.703 (0.502-0.904) for late PE cases. 10 PLGF has better detection rate for PE and late PE.…”

“…[2][3][4] Different biochemical markers like Placental protein 13 (PP-13), soluble FMS like tyrosine kinase (sFlt-1), soluble endoglin (s-Eng) and placental growth factor (PLGF) have been investigated based on pathophysiology of PE such as placental dysfunction, release of cytokines, activation of coagulation cascade and endothelial dysfunction. [2][3][4] Evidence supports that altered levels of these becomes apparent from first trimester of pregnancy in future pre-eclamptic patients. Of these, placental growth factor (PLGF), a small hematological molecule, is one of the most promising.…”