Serum biomarkers combined with uterine artery Doppler in prediction of preeclampsia

Abstract

First-trimester screening may be a major advantage over a second-trimester approach since it opens prospects for early and more efficient interventions. The aim of the current study was to evaluate whether the measurement of maternal serum inhibin A, activin A and placental growth factor (PlGF) at three to four months gestation with the second-trimester uterine artery pulsatility index (PI) are useful in predicting preeclampsia in a group of nulliparous women. All the patients also underwent uterine artery Doppler examination to measure the PI at 22–24 weeks gestation. Inhibin A, activin A and PlGF were measured using an ELISA by an examiner who was blinded to the pregnancy outcome. Thirty-eight cases with preeclampsia and 100 controls were analyzed. Second-trimester uterine artery PI and marker levels were expressed as multiples of the median (MoM). The uterine artery PI was increased in pregnancies with preeclampsia compared with controls. In pregnancies that developed preeclampsia, the uterine artery PI was increased (1.61±0.047 vs. 1.02±0.049, P<0.001), as was the level of inhibin A (1.72±0.023 vs. 1.03±0.063, P<0.001) and the level of activin A (1.68±0.38 vs. 1.06±0.42, P<0.001) compared with the controls. In contrast, the level of PlGF was decreased in pregnancies that developed preeclampsia compared with the controls (0.69±0.23 vs. 1.00±0.26, P<0.001). A combination of activin A, PlGF and uterine artery PI gave an AUC of 0.915 (95% CI, 0.812–0.928; P<0.001) with a sensitivity of 91% at a specificity of 82%. In our study, we demonstrated that both serum inhibin A and activin A levels were increased, while the PlGF level was decreased in the early second-trimester in women who developed preeclampsia.

Use of first‐trimester placenta growth factor concentration to predict hypertensive disorders of pregnancy in a low‐risk Asian population

“…Placenta growth factor (PlGF) is a marker of angiogenesis that can increase the detection rate of pre‐eclampsia when combined with other variables for screening . Nonetheless, the efficacy of PlGF and its optimum cutoff level have not been studied in low‐risk Asian populations.…”

Nitric oxide/Asymmetric Dimethylarginine Axis may Interplay With Some Sex Hormones for Pathogenesis and Severity of Pre-eclampsia: Study controlled by Uterine Arterial Doppler.

“…Recently, Chang et al(25) found the predictive model consisting of mean arterial pressure (MAP), UAPI and serum biomarkers showed predictive value for the early (11-13 weeks GA) diagnosis of early PE with fetal growth retardation of 73.2%.Moreover, Tsiakkas et al(26) reported that combined screening by maternal factors, MAP, UAPI and biomarkers predicted 98% of preterm-PE and 49% of term-PE, at a false-positive rate of 5%. Also, Li et al(27) reported that in pregnancies that developed PE, the UAPI was increased and a combination of biomarkers and UAPI gave an AUC of 0.915 with 91% sensitivity at 82% specificity.The reported positive significant correlation between high SBP, a diagnostic criterion for PE and at 12-w GA high BMI and serum ADMA levels and the negative significant correlation between high SBP and serum NO and E2 levels spot light on a possible relationship between disturbed NO/ADMA axis, obesity, disturbed sex hormonal milieu on one side and the development of PE on the other side.…”

Prediction of Preeclampsia by Uterine Artery Doppler Examination and Placental Growth Factor, Endoglin and Pregnancy-associated Plasma Protein Levels in Maternal Serum at 11-13+6 Pregnancy Week

“…Li et al (26) demonstrated that UtA PI at early secondtrimester was increased in pregnancies that developed PE (1.61±0.047 vs. 1.02±0.049, p<0.001). In contrast, the level of PlGF was decreased in preeclamptic group compared to controls (0.69±0.23 vs. 1.00±0.26, p<0.001) (26).…”