Utility of a single mid-trimester measurement of plasminogen activator Type 1 and fibronectin to predict preeclampsia in pregnancy

Abstract

Background:Preeclampsia (PE) is the second most common cause of maternal death after obstetric hemorrhage in Africa, a resource-limited region. This study was designed to examine the potential usefulness of a single screening plasma plasminogen activator inhibitor-1 (PAI-1) and fibronectin (FN) level for the prediction of PE in pregnant women.Materials and Methods:In a cohort of 180 pregnant women who were normotensive at baseline, venous blood samples were obtained before 20 weeks of gestation for the assay of plasma levels of PAI-1 and FN levels measured by enzyme-linked immunoassay technique. Twenty nonpregnant normotensive women were also evaluated as a control group. Outcomes of gestation were evaluated and correlated with the plasma levels of PAI and FN measured at mid-trimester. Mean plasma values of PAI-1 and FN were also compared between the different outcome groups.Results:Plasma PAI-1 level was significantly higher in the pregnant women (8.68 ± 0.56 ng/ml) than in nonpregnant controls (5.55 ± 0.32 ng/ml) (P = 0.01). However, plasma FN did not show any significant difference in pregnant women (2.60 ± 0.37 μg/ml) and nonpregnant controls (2.60 ± 0.23 μg/ml) (P = 0.9). Mid-trimester mean plasma PAI-1 level measured in women who developed PE (7.08 ± 5.49 ng/ml, n = 12) and gestational hypertension (GH) (9.78 ± 6.2 ng/ml, n = 13) was not significantly different in comparison to normotensive pregnant women (8.78 ± 5.63 ng/ml, n = 153) (P = 0.75). Likewise, the mean FN level in women who developed PE was also not significantly different from nonpreeclamptics; however, the FN level in the pregnant women who developed GH was significantly different from women who remained normotensive throughout pregnancy (P = 0.02).Conclusion:Single mid-trimester assessment of PAI-1 and FN levels in maternal plasma was not found to be useful in predicting PE as an outcome of pregnancy in the study population.

Prevalence of hypertensive disorders of pregnancy and pregnancy outcomes in Sub-Saharan Africa: A systematic review and meta-analysis

“…The characteristics of the cross-sectional, 9 , 35 , 36 , 40 , 42 , 46 – 89 prospective, or retrospective cohort and longitudinal studies 5 , 10 , 37 – 39 , 41 , 90 – 103 ...…”

“…The characteristics of the cross-sectional, 9,35,36,40,42, prospective, or retrospective cohort and longitudinal studies 5,10,[37][38][39]41,[90][91][92][93][94][95][96][97][98][99][100][101][102][103] included in this review from 19 Sub-Saharan African countries are summarized in Table 1. The majority of studies were conducted in Nigeria, Ethiopia, and Tanzania, which are 21, 16, and 6, respectively.…”

Predictive value of the second‐trimester fibronectin concentration for severe preeclampsia: A prospective nested case–control study in China

“…The authors concluded that second-trimester assessment of FN levels in maternal plasma was not found to be useful in predicting PE. 42 Paneva-Masin et al also concluded that the measurement of plasma FN might be of diagnostic value in PE but could not be considered a useful predictor for PE. 43 In the abovementioned previous reports, higher FN in the secondtrimester maternal plasma of PE pregnancies was observed in most reports except one report of Ajibola et al 42 17,35,36,[40][41][42] Five reports suggested that FN had predictive value for PE, while the other three reports concluded that FN was not a useful predictor for PE.…”

“…The concentration of plasma FN was very low (2-5 mg/L) in the two reports using ELISA. 36,42 Even in reports using the same method, different instruments and commercial kits were used. Different methods, instruments, and kits detected different FN variants.…”

Are the Circulating Levels of Copeptin and Fibronectin Dysregulated in Preeclamptic South African Black Women?

“…We were able to overcome this drawback by limiting our recruitment to women with early onset PE. However, Ajibola's group failed to demonstrate any significant differences in plasma fibronectin levels between PE and normotensive pregnant women (16). The potential utility of fibronectin as a biomarker for PE prediction received some attention although concerns increased surrounding its sensitivity (17).…”