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Creswell L, O’Gorman N, Palmer KR, da Silva Costa F, Rolnik DL. Perspectives on the Use of Placental Growth Factor (PlGF) in the Prediction and Diagnosis of Pre-Eclampsia: Recent Insights and Future Steps. Int J Womens Health 2023; 15:255-271. [PMID: 36816456 PMCID: PMC9936876 DOI: 10.2147/ijwh.s368454] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 02/03/2023] [Indexed: 02/16/2023] Open
Abstract
Pre-eclampsia (PE) is a complex multisystem disease of pregnancy that is becoming increasingly recognized as a state of angiogenic imbalance characterized by low concentrations of placental growth factor (PlGF) and elevated soluble fms-like tyrosine kinase (sFlt-1). PlGF is a protein highly expressed by the placenta with vasculogenic and angiogenic properties, which has a central role in spiral artery remodeling and the development of a low-resistance placental capillary network. PlGF concentrations are significantly lower in women with preterm PE, and these reduced levels have been shown to precede the clinical onset of disease. Subsequently, the clinical utility of maternal serum PlGF has been extensively studied in singleton gestations from as early as 11 to 13 weeks' gestation, utilizing a validated multimarker prediction model, which performs superiorly to the National Institute for Health and Care Excellence (NICE) and American College of Obstetricians and Gynecologists (ACOG) guidelines in the detection of preterm PE. There is extensive research highlighting the role of PlGF-based testing utilizing commercially available assays in accelerating the diagnosis of PE in symptomatic women over 20 weeks' gestation and predicting time-to-delivery, allowing individualized risk stratification and appropriate antenatal surveillance to be determined. "Real-world" data has shown that interpretation of PlGF-based test results can aid clinicians in improving maternal outcomes and a growing body of evidence has implied a role for sFlt-1/PlGF in the prognostication of adverse pregnancy and perinatal events. Subsequently, PlGF-based testing is increasingly being implemented into obstetric practice and is advocated by NICE. This literature review aims to provide healthcare professionals with an understanding of the role of angiogenic biomarkers in PE and discuss the evidence for PlGF-based screening and triage. Prospective studies are warranted to explore if its implementation significantly improves perinatal outcomes, explore the value of repeat PlGF testing, and its use in multiple pregnancies.
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Affiliation(s)
- Lyndsay Creswell
- Coombe Women and Infants University Hospital, Dublin, Ireland,Correspondence: Lyndsay Creswell, Coombe Women and Infants University Hospital, Cork Street, Dublin, D08XW7X, Ireland, Tel +44 7754235257, Email
| | - Neil O’Gorman
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Kirsten Rebecca Palmer
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Fabricio da Silva Costa
- Maternal Fetal Medicine Unit, Gold Coast University Hospital and School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Daniel Lorber Rolnik
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
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Monosomy X in isogenic human iPSC-derived trophoblast model impacts expression modules preserved in human placenta. Proc Natl Acad Sci U S A 2022; 119:e2211073119. [PMID: 36161909 DOI: 10.1073/pnas.2211073119] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Mammalian sex chromosomes encode homologous X/Y gene pairs that were retained on the Y chromosome in males and escape X chromosome inactivation (XCI) in females. Inferred to reflect X/Y pair dosage sensitivity, monosomy X is a leading cause of miscarriage in humans with near full penetrance. This phenotype is shared with many other mammals but not the mouse, which offers sophisticated genetic tools to generate sex chromosomal aneuploidy but also tolerates its developmental impact. To address this critical gap, we generated X-monosomic human induced pluripotent stem cells (hiPSCs) alongside otherwise isogenic euploid controls from male and female mosaic samples. Phased genomic variants in these hiPSC panels enable systematic investigation of X/Y dosage-sensitive features using in vitro models of human development. Here, we demonstrate the utility of these validated hiPSC lines to test how X/Y-linked gene dosage impacts a widely used model for human syncytiotrophoblast development. While these isogenic panels trigger a GATA2/3- and TFAP2A/C-driven trophoblast gene circuit irrespective of karyotype, differential expression implicates monosomy X in altered levels of placental genes and in secretion of placental growth factor (PlGF) and human chorionic gonadotropin (hCG). Remarkably, weighted gene coexpression network modules that significantly reflect these changes are also preserved in first-trimester chorionic villi and term placenta. Our results suggest monosomy X may skew trophoblast cell type composition and function, and that the combined haploinsufficiency of the pseudoautosomal region likely plays a key role in these changes.
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Romero Infante XC, Uriel M, Gutiérrez A, Hernández MF, Hernández AF, Jiménez LC, Malagón-Rojas JN, Rincón Franco S. Behavior of the Genetic Markers at Screening during the First Trimester of Pregnancy in Euploid Fetuses. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:646-653. [PMID: 35667377 PMCID: PMC9948148 DOI: 10.1055/s-0042-1744461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study aims to describe the behavior of chromosomopathy screenings in euploid fetuses. METHODS This is a prospective descriptive study with 566 patients at 11 to 14 weeks of gestation. The associations between ultrasound scans and serological variables were studied. For the quantitative variables we used the Spearman test; for the qualitative with quantitative variables the of Mann-Whitney U-test; and for qualitative variables, the X2 test was applied. Significance was set at p ≤ 0.05. RESULTS We have found that gestational age has correlation with ductus venosus, nuchal translucency, free fraction of β subunit of human chorionic gonadotropin, pregnancy-associated plasma protein-A and placental growth factor; there is also a correlation between history of miscarriages and nasal bone. Furthermore, we correlated body mass index with nuchal translucency, free fraction of β subunit of human chorionic gonadotropin, and pregnancy-associated plasma protein-A. Maternal age was associated with free fraction of β subunit of human chorionic gonadotropin and pregnancy-associated plasma protein-A. CONCLUSION Our study demonstrates for the first time the behavior of the biochemical and ultrasonographic markers of chromosomopathy screenings during the first trimester in euploid fetuses in Colombia. Our information is consistent with international reference values. Moreover, we have shown the correlation of different variables with maternal characteristics to determine the variables that could help with development of a screening process during the first trimester with high detection rates.
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Affiliation(s)
- Ximena Carolina Romero Infante
- Universidad El Bosque, El Bosque Research Group of Maternal Fetal Medicine and Gynecology, Ecodiagnóstico El Bosque SAS, Los Cobos Medical Center, Bogotá, Colombia
| | - Montserrat Uriel
- Universidad El Bosque, El Bosque Research Group of Maternal Fetal Medicine and Gynecology, Ecodiagnóstico El Bosque SAS, Los Cobos Medical Center, Bogotá, Colombia
| | - Alejandra Gutiérrez
- Universidad El Bosque, El Bosque Research Group of Maternal Fetal Medicine and Gynecology, Bogotá, Colombia
| | - María Fernanda Hernández
- Universidad El Bosque, El Bosque Research Group of Maternal Fetal Medicine and Gynecology, Bogotá, Colombia
| | - Andres Felipe Hernández
- Universidad El Bosque, El Bosque Research Group of Maternal Fetal Medicine and Gynecology, Bogotá, Colombia
| | - Laura Catalina Jiménez
- Universidad El Bosque, El Bosque Research Group of Maternal Fetal Medicine and Gynecology, Bogotá, Colombia
| | | | - Sara Rincón Franco
- Universidad El Bosque, El Bosque Research Group of Maternal Fetal Medicine and Gynecology, Ecodiagnóstico El Bosque SAS, Bogotá, Colombia
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Sin AWT, Poon LC, Chaemsaithong P, Wah YMI, Hui SYA, Ting YH, Law KM, Leung TY, Sahota DS. Impact of replacing or adding placental growth factor on Down syndrome screening: A prospective cohort study. Prenat Diagn 2021; 41:1111-1117. [PMID: 34166535 DOI: 10.1002/pd.5986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/17/2021] [Accepted: 05/23/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To assess whether adding placental growth factor (PlGF) or replacing pregnancy-associated plasma protein-A (PAPP-A) improves the first trimester combined test performance for trisomy 21. METHODS A total of 11,518 women with a singleton pregnancy who underwent the first trimester combined test between December 2016 and December 2019 were included. PlGF was measured and estimated term risk for trisomy 21 was calculated by (1) adding PlGF to the combined test and (2) replacing PAPP-A with PlGF. RESULTS Twenty-nine pregnancies had trisomy 21. The combined tests detection rate (DR), false positive rate (FPR) and screen positive rate (SPR) were 89.7%, 5.7% and 6% respectively. DR when adding PlGF to the combined test or replacing PAPP-A remained unchanged. Replacing PAPP-A by PlGF increased FPR and SPR to 6.2% and 6.4% respectively. Adding PlGF to the combined test gave FPR and SPR rates of 5.5% and 5.7% respectively. Change in FPR and SPR was not significant (p > 0.1 for all). CONCLUSION Adding PlGF to the combined test or replacing PAPP-A with PlGF did not improve trisomy 21 DR and resulted in a non-significant marginal change in FPR and SPR.
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Affiliation(s)
- Angela Wing To Sin
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - Liona C Poon
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - Piya Chaemsaithong
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - Yi Man Isabella Wah
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - Shuk Yi Annie Hui
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - Yuen Ha Ting
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - Kwok Ming Law
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - Tak Yeung Leung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - Daljit Singh Sahota
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
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Mazer Zumaeta A, Wright A, Syngelaki A, Maritsa VA, Bardani E, Nicolaides KH. Screening for trisomy at 11-13 weeks' gestation: use of pregnancy-associated plasma protein-A, placental growth factor or both. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 56:408-415. [PMID: 32621353 DOI: 10.1002/uog.22140] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 06/24/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Serum pregnancy-associated plasma protein-A (PAPP-A) and placental growth factor (PlGF) at 11-13 weeks' gestation are reduced in pregnancies with fetal trisomy and in those that subsequently develop pre-eclampsia (PE). In screening for trisomy, the established biochemical marker is PAPP-A, whereas in screening for PE, the preferred marker is PlGF. The objective of this study was to examine the impact of replacing PAPP-A by PlGF in first-trimester screening for trisomies 21, 18 and 13 by maternal age, fetal nuchal translucency thickness (NT) and free β-human chorionic gonadotropin (β-hCG). METHODS This was a prospective screening study in singleton pregnancies for trisomies 21, 18 and 13 by a combination of maternal age, fetal NT and serum PAPP-A and free β-hCG at 11-13 weeks' gestation in which we also measured PlGF. Multiples of the median (MoM) values were calculated for PAPP-A, free β-hCG and PlGF. The dataset was split randomly into training and test datasets of roughly equal size, and the parameters for PlGF obtained from the training dataset were used in risk calculation for the test dataset. Standardized detection rates were computed by obtaining the likelihood ratios for biochemistry and fetal NT for trisomy-21, -18 and -13 pregnancies in the sample and then applying these to each year of maternal age from 12 to 50 to estimate the age-specific detection rates. These were then weighted according to the maternal age distributions of trisomy-21, -18 and -13 pregnancies in England and Wales in 2018. Similarly, standardized false-positive rates (FPR) were computed by obtaining the likelihood ratios for biochemistry and NT, as appropriate, in normal pregnancies in the sample and then applying these to each year of maternal age from 12 to 50 to estimate the age-specific FPRs. A modeling approach was used to assess the performance of screening according to gestational age at biochemical testing. RESULTS The study population of 71 266 pregnancies included 70 858 (99.4%) with normal fetal karyotype or birth of a phenotypically normal neonate and 263 with trisomy 21, 109 with trisomy 18 and 36 with trisomy 13. There are five main findings of this study. First, the performance of screening for trisomy by the first-trimester combined test or the combined test in which PAPP-A is replaced by PlGF is substantially better at 11 than at 13 weeks' gestation; for example, the detection rates of trisomy 21 by the combined test were 94%, 90% and 84%, at 5% FPR, when testing was carried out at 11, 12 and 13 weeks, respectively, and the corresponding values in screening by a test in which PAPP-A is replaced by PlGF were 90%, 87% and 86%, respectively. Second, in trisomy-21 pregnancies, the deviation of median PAPP-A MoM from normal decreases with increasing gestational age, whereas the deviation in PlGF does not change with gestational age. Third, the performance of screening for trisomy 21 during the 11th and 12th gestational weeks is superior if screening includes PAPP-A rather than PlGF, whereas during the 13th week the performance is slightly higher with the use of PlGF rather than PAPP-A. Fourth, in our population with mean gestational age at testing of 12.7 weeks, screening by maternal age, fetal NT, serum free β-hCG and serum PAPP-A predicted 88%, 96% and 97% of cases of fetal trisomies 21, 18 and 13, respectively, at a FPR of 5%; the respective values in screening by a test in which PAPP-A is replaced by PlGF were 85%, 96% and 96%. Fifth, addition of serum PlGF does not improve the prediction of trisomy provided by maternal age, fetal NT and serum free β-hCG and PAPP-A. CONCLUSION In first-trimester screening for trisomy, the preferred biochemical marker is PAPP-A rather than PlGF, especially when biochemical testing is carried out during the 11th week of gestation or earlier. However, if PlGF was to be used rather than PAPP-A, the same detection rate can be achieved but at a higher FPR. This may be an acceptable compromise to minimize cost and achieve effective screening for both trisomy and PE. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A Mazer Zumaeta
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - A Wright
- Institute of Health Research, University of Exeter, Exeter, UK
| | - A Syngelaki
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - V A Maritsa
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - E Bardani
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
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Badeghiesh A, Volodarsky-Perel A, Lasry A, Hemmings R, Gil Y, Balayla J. Use of Placental Growth Factor for Trisomy 21 Screening in Pregnancy: A Systematic Review. AJP Rep 2020; 10:e234-e240. [PMID: 33094011 PMCID: PMC7571571 DOI: 10.1055/s-0040-1713785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 03/05/2020] [Indexed: 11/03/2022] Open
Abstract
Background Prenatal serum screening is an important modality to screen for aneuploidy in pregnancy. The addition of placental growth factor (PLGF) to screen for trisomy 21 remains controversial. Objective To determine whether the addition of PLGF to combined serum aneuploidy screening improves detection rates (DRs) for trisomy 21. Study Design We performed a systematic review of the literature until October 2019 to determine the benefits of adding PLGF to prenatal screening. We performed a goodness-of-fit test and retrieved the coefficient of determinations ( R 2 ) as a function of false positive rates (FPRs), providing mean-weighted improvements in the DRs after accounting for PLGF levels. Results We identified 51 studies, of which 8 met inclusion criteria (834 aneuploidy cases and 105,904 euploid controls). DRs were proportional to FPR across all studies, ranging from 59.0 to 95.3% without PLGF and 61.0 to 96.3% with PLGF (FPR 1-5%). Goodness-of-fit regression analysis revealed a logarithmic distribution of DRs as a function of the FPR, with R 2 = 0.109 (no PLGF) and R 2 = 0.06 (PLGF). Two-sample Kolmogorov-Smirnov's test reveals a p -value of 0.44. Overall, addition of PLGF improves DRs of 3.3% for 1% FPR, 1.7% for 3% FPR, and 1.4% for 5% FPR, respectively. Conclusion Addition of PLGF to prenatal screening using serum analytes mildly improves trisomy 21 DRs as a function of FPRs.
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Affiliation(s)
- Ahmad Badeghiesh
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
| | - Alexander Volodarsky-Perel
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada.,Lady Davis Research Institute, Jewish General Hospital, Montreal, Quebec, Canada
| | - Ariane Lasry
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
| | - Robert Hemmings
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada.,Department of Obstetrics and Gynecology, CIUSS Ouest de l'Ile, Montreal, Quebec, Canada
| | - Yaron Gil
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
| | - Jacques Balayla
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
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First Trimester Screening for Fetal Aneuploidies Using Placental Growth Factor: The Great Obstetrical Syndrome (GOS) Study. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 40:1044-1049. [PMID: 30103877 DOI: 10.1016/j.jogc.2017.11.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 11/16/2017] [Accepted: 11/16/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE This study sought to estimate the ability of first trimester maternal serum placental growth factor (PlGF) to identify fetal aneuploidies. METHODS A prospective cohort study of singleton pregnancy at 11 to 13 weeks was conducted. Maternal serum PlGF concentration was measured using BRAHMS PlGF plus KRYPTOR automated assays (Thermo Scientific BRAHMS, Hennigsdorf, Germany). PlGF and nuchal translucency were log-transformed and reported as multiples of the median (MoM) adjusted for crown-rump length. Detection rates were calculated using receiver-operator characteristic curves. RESULTS The study observed 21 cases of fetal aneuploidies (0.4%) out of 4765 participants. Trisomy 21 (13 cases; 0.85 MoM; interquartile range [IQR] 0.80-0.93), trisomy 18 (two cases; 0.77 MoM; IQR 0.66-0.87) and trisomy 13 (two cases; 0.68 MoM; IQR 0.61-0.75) were associated with low PlGF concentrations. The low PlGF values observed in the cases of monosomy X (two cases; 0.85 MoM; IQR 0.82-0.88, P = 0.05), triploidy (0.78 MoM, P = 0.11), and 47,XX,i(22)(p10) (0.18 MoM, P = 0.08) were not statistically different from the controls. A model including maternal age, nuchal translucency, and PlGF could have identified all (95% CI 83%-100%) cases of trisomy 21 and six of the other fetal aneuploidies (75%) at a false-positive rate of 9%. CONCLUSION Low first trimester PlGF is associated with an increased risk of fetal aneuploidy. PlGF combined with first trimester ultrasound (nuchal translucency, uterine artery Doppler, and early fetal anatomy) could identify not only women at high risk for preeclampsia, but also fetuses at high risk of aneuploidy for optimal further testing (non-invasive testing for common aneuploidy screening or chorionic villus sampling for full screening and diagnosis).
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Gerbaud P, Murthi P, Guibourdenche J, Guimiot F, Sarazin B, Evain-Brion D, Badet J, Pidoux G. Study of Human T21 Placenta Suggests a Potential Role of Mesenchymal Spondin-2 in Placental Vascular Development. Endocrinology 2019; 160:684-698. [PMID: 30715257 DOI: 10.1210/en.2018-00826] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 01/25/2019] [Indexed: 12/12/2022]
Abstract
Placental development is particularly altered in trisomy of chromosome 21 (T21)-affected pregnancies. We previously described in T21-affected placentae an abnormal paracrine crosstalk between the villus mesenchymal core and villus trophoblasts. T21-affected placentae are known to be characterized by their hypovascularity. However, the causes of this anomaly remain not fully elucidated. Therefore, the hypothesis of an abnormal paracrine crosstalk between fetal mesenchymal core and placental endothelial cells (PLECs) was evocated. Villus mesenchymal cells from control (CMCs) and T21 placentae (T21MCs) were isolated and grown in culture to allow their characterization and collection of conditioned media for functional analyses (CMC-CM and T21MC-CM, respectively). Interestingly, PLEC proliferation and branching ability were less stimulated by T21MC-CM than by CMC-CM. Protein array analysis identified secreted proangiogenic growth factors in CMC-CM, which were reduced in T21MC-CM. Combined mass spectrometry and biochemical analysis identified spondin-2 as a factor decreased in T21MC-CM compared with CMC-CM. We found that exogenous spondin-2 stimulated PLEC proliferation and established that T21MC-CM supplemented with spondin-2 recovered conditioned media ability to induce PLEC proliferation and angiogenesis. Hence, this study demonstrates a crosstalk between villus mesenchymal and fetal endothelial cells, in which spondin-2 secreted from mesenchymal cells plays a central role in placental vascular functions. Furthermore, our results also suggest that a reduction in spondin-2 secretion may contribute to the pathogenesis of T21 placental hypovascularity.
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Affiliation(s)
- Pascale Gerbaud
- INSERM, UMR-S 1139, Paris, France
- INSERM, UMR-S 1180, Châtenay-Malabry, France
| | - Padma Murthi
- Department of Maternal-Fetal Medicine, Pregnancy Research Centre, Royal Women's Hospital, University of Melbourne, Parkville, Victoria, Australia
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Parkville, Victoria, Australia
- Department of Physiology, Monash University, Clayton, Victoria, Australia
- Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Jean Guibourdenche
- INSERM, UMR-S 1139, Paris, France
- Faculté de Pharmacie, Université Paris Descartes, Paris, France
- Service d'Hormonologie, Assistance Publique-Hôpitaux de Paris, CHU Cochin, Paris, France
- Fondation PremUP, Paris, France
| | - Fabien Guimiot
- Unité de Foetopathologie, Assistance Publique-Hôpitaux de Paris, CHU Robert Debré, Paris, France
| | | | - Danièle Evain-Brion
- INSERM, UMR-S 1139, Paris, France
- Faculté de Pharmacie, Université Paris Descartes, Paris, France
- Fondation PremUP, Paris, France
| | - Josette Badet
- INSERM, UMR-S 1139, Paris, France
- Faculté de Pharmacie, Université Paris Descartes, Paris, France
| | - Guillaume Pidoux
- INSERM, UMR-S 1139, Paris, France
- INSERM, UMR-S 1180, Châtenay-Malabry, France
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Huang T, Meschino WS, Rashid S, Dennis A, Mak-Tam E, Cuckle H. Enhanced First Trimester Aneuploidy Screening with Placental Growth Factor and Alpha Feto-Protein: Detection of Trisomies 18 and 13. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:1295-1301. [PMID: 30025867 DOI: 10.1016/j.jogc.2018.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 01/03/2018] [Accepted: 01/03/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To assess the performance of first trimester combined screening (FTS) when enhanced with placental growth factor and alpha feto-protein in the detection of trisomies 18 and 13. METHODS A retrospective case-control study. Marker parameters were derived using frozen serum samples. Multivariate Gaussian modelling predicted the detection rate (DR) and false-positive rate (FPR) for trisomies 18 and 13 with FTS and enhanced first trimester screening (eFTS) using the risk of trisomy 21 alone and an additional risk cut-off for trisomy 18, or trisomies 18 or 13. RESULTS There were 83 trisomy 18, 22 trisomy 13, and 588 controls. The median placental growth factor levels in trisomies 18 and 13 were 0.75 and 0.65 multiple of the median of controls, respectively (both P < 0.0001). There were no statistically significant differences in alpha feto-protein levels. Modelling predicts that using a trisomy 21 risk cut-off alone, at FPR of 3%, eFTS increases the DR for trisomies 18 and 13 by 0.6-0.8% compared with FTS. Additionally using a trisomy 18 risk cut-off, at an extra FPR of 0.2%, eFTS increased the DR by 0.6-0.9% over FTS; using a trisomy 18 or 13 risk cut-off did not further increase detection for FTS or eFTS. The increase in DR was greater at higher FPR. CONCLUSION eFTS increases the detection of trisomies 18 and 13 to a small extent.
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Affiliation(s)
- Tianhua Huang
- Genetics Program, North York General Hospital, Toronto, ON; Better Outcomes Registry & Network (BORN) Ontario, Ottawa, ON; The Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON; Department of Obstetrics & Gynaecology, University of Toronto, Toronto, ON.
| | - Wendy S Meschino
- Genetics Program, North York General Hospital, Toronto, ON; Department of Paediatrics, University of Toronto, Toronto, ON
| | - Shamim Rashid
- Genetics Program, North York General Hospital, Toronto, ON
| | - Alan Dennis
- Genetics Program, North York General Hospital, Toronto, ON
| | - Ellen Mak-Tam
- Genetics Program, North York General Hospital, Toronto, ON
| | - Howard Cuckle
- Obstetrics and Gynecology, Columbia University Medical Center, New York, NY
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Bhuwapathanapun M, Pratumvinit B, Lahfahroengron P, Hanyongyuth S, Phaophan A, Pooliam J, Wataganara T. Serum-free placental growth factor isoform 1 at 11–13-week gestation: effects of maternal factors, mean arterial pressure, placental volume, and uterine artery pulsatility index. J Matern Fetal Neonatal Med 2017; 31:2813-2819. [DOI: 10.1080/14767058.2017.1357168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Maolee Bhuwapathanapun
- Division of Maternal–Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Busadee Pratumvinit
- Department of Clinical Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Piyaporn Lahfahroengron
- Division of Maternal–Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sithikan Hanyongyuth
- Department of Clinical Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Amprapha Phaophan
- Division of Maternal–Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Julaporn Pooliam
- Division of Clinical Epidemiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tuangsit Wataganara
- Division of Maternal–Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Han J, Liu H, Xu ZP, Cuckle H, Sahota D, Li DZ, Liao C. Maternal serum PlGF (placental growth factor) in Chinese women in the first trimester undergoing screening for Down syndrome. Eur J Obstet Gynecol Reprod Biol 2016; 201:166-70. [DOI: 10.1016/j.ejogrb.2016.03.046] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 03/23/2016] [Accepted: 03/29/2016] [Indexed: 02/06/2023]
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Alldred SK, Takwoingi Y, Guo B, Pennant M, Deeks JJ, Neilson JP, Alfirevic Z. First trimester serum tests for Down's syndrome screening. Cochrane Database Syst Rev 2015; 2015:CD011975. [PMID: 26617074 PMCID: PMC6465076 DOI: 10.1002/14651858.cd011975] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Down's syndrome occurs when a person has three, rather than two copies of chromosome 21; or the specific area of chromosome 21 implicated in causing Down's syndrome. It is the commonest congenital cause of mental disability and also leads to numerous metabolic and structural problems. It can be life-threatening, or lead to considerable ill health, although some individuals have only mild problems and can lead relatively normal lives. Having a baby with Down's syndrome is likely to have a significant impact on family life.Noninvasive screening based on biochemical analysis of maternal serum or urine, or fetal ultrasound measurements, allows estimates of the risk of a pregnancy being affected and provides information to guide decisions about definitive testing. However, no test can predict the severity of problems a person with Down's syndrome will have. OBJECTIVES The aim of this review was to estimate and compare the accuracy of first trimester serum markers for the detection of Down's syndrome in the antenatal period, both as individual markers and as combinations of markers. Accuracy is described by the proportion of fetuses with Down's syndrome detected by screening before birth (sensitivity or detection rate) and the proportion of women with a low risk (normal) screening test result who subsequently had a baby unaffected by Down's syndrome (specificity). SEARCH METHODS We conducted a sensitive and comprehensive literature search of MEDLINE (1980 to 25 August 2011), Embase (1980 to 25 August 2011), BIOSIS via EDINA (1985 to 25 August 2011), CINAHL via OVID (1982 to 25 August 2011), The Database of Abstracts of Reviews of Effectiveness (The Cochrane Library 25 August 2011), MEDION (25 August 2011), The Database of Systematic Reviews and Meta-Analyses in Laboratory Medicine (25 August 2011), The National Research Register (Archived 2007), Health Services Research Projects in Progress database (25 August 2011). We did forward citation searching ISI citation indices, Google Scholar and PubMed 'related articles'. We did not apply a diagnostic test search filter. We also searched reference lists and published review articles. SELECTION CRITERIA We included studies in which all women from a given population had one or more index test(s) compared to a reference standard (either chromosomal verification or macroscopic postnatal inspection). Both consecutive series and diagnostic case-control study designs were included. Randomised trials where individuals were randomised to different screening strategies and all verified using a reference standard were also eligible for inclusion. Studies in which test strategies were compared head-to-head either in the same women, or between randomised groups were identified for inclusion in separate comparisons of test strategies. We excluded studies if they included less than five Down's syndrome cases, or more than 20% of participants were not followed up. DATA COLLECTION AND ANALYSIS We extracted data as test positive or test negative results for Down's and non-Down's pregnancies allowing estimation of detection rates (sensitivity) and false positive rates (1-specificity). We performed quality assessment according to QUADAS (Quality Assessment of Diagnostic Accuracy Studies) criteria. We used hierarchical summary ROC meta-analytical methods or random-effects logistic regression methods to analyse test performance and compare test accuracy as appropriate. Analyses of studies allowing direct and indirect comparisons between tests were undertaken. MAIN RESULTS We included 56 studies (reported in 68 publications) involving 204,759 pregnancies (including 2113 with Down's syndrome). Studies were generally of good quality, although differential verification was common with invasive testing of only high-risk pregnancies. We evaluated 78 test combinations formed from combinations of 18 different tests, with or without maternal age; ADAM12 (a disintegrin and metalloprotease), AFP (alpha-fetoprotein), inhibin, PAPP-A (pregnancy-associated plasma protein A, ITA (invasive trophoblast antigen), free βhCG (beta human chorionic gonadotrophin), PlGF (placental growth factor), SP1 (Schwangerschafts protein 1), total hCG, progesterone, uE3 (unconjugated oestriol), GHBP (growth hormone binding protein), PGH (placental growth hormone), hyperglycosylated hCG, ProMBP (proform of eosinophil major basic protein), hPL (human placental lactogen), (free αhCG, and free ßhCG to AFP ratio. Direct comparisons between two or more tests were made in 27 studies.Meta-analysis of the nine best performing or frequently evaluated test combinations showed that a test strategy involving maternal age and a double marker combination of PAPP-A and free ßhCG significantly outperformed the individual markers (with or without maternal age) detecting about seven out of every 10 Down's syndrome pregnancies at a 5% false positive rate (FPR). Limited evidence suggested that marker combinations involving PAPP-A may be more sensitive than those without PAPP-A. AUTHORS' CONCLUSIONS Tests involving two markers in combination with maternal age, specifically PAPP-A, free βhCG and maternal age are significantly better than those involving single markers with and without age. They detect seven out of 10 Down's affected pregnancies for a fixed 5% FPR. The addition of further markers (triple tests) has not been shown to be statistically superior; the studies included are small with limited power to detect a difference.The screening blood tests themselves have no adverse effects for the woman, over and above the risks of a routine blood test. However some women who have a 'high risk' screening test result, and are given amniocentesis or chorionic villus sampling (CVS) have a risk of miscarrying a baby unaffected by Down's. Parents will need to weigh up this risk when deciding whether or not to have an amniocentesis or CVS following a 'high risk' screening test result.
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Affiliation(s)
- S Kate Alldred
- The University of LiverpoolDepartment of Women's and Children's HealthFirst Floor, Liverpool Women's NHS Foundation TrustCrown StreetLiverpoolUKL8 7SS
| | - Yemisi Takwoingi
- University of BirminghamPublic Health, Epidemiology and BiostatisticsEdgbastonBirminghamUKB15 2TT
| | - Boliang Guo
- University of NottinghamSchool of MedicineCLAHRC, C floor, IHM, Jubilee CampusUniversity of Nottingham, Triumph RoadNottinghamEast MidlandsUKNG7 2TU
| | - Mary Pennant
- Cambridgeshire County CouncilPublic Health DirectorateCambridgeUK
| | - Jonathan J Deeks
- University of BirminghamPublic Health, Epidemiology and BiostatisticsEdgbastonBirminghamUKB15 2TT
| | - James P Neilson
- The University of LiverpoolDepartment of Women's and Children's HealthFirst Floor, Liverpool Women's NHS Foundation TrustCrown StreetLiverpoolUKL8 7SS
| | - Zarko Alfirevic
- The University of LiverpoolDepartment of Women's and Children's HealthFirst Floor, Liverpool Women's NHS Foundation TrustCrown StreetLiverpoolUKL8 7SS
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Sánchez O, Domínguez C, Ruiz A, Ribera I, Alijotas J, Cabero L, Carreras E, Llurba E. Angiogenic Gene Expression in Down Syndrome Fetal Hearts. Fetal Diagn Ther 2015; 40:21-7. [PMID: 26513650 DOI: 10.1159/000441356] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 09/23/2015] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Forty percent of Down syndrome (DS) fetuses have congenital heart defects (CHD). An abnormal angiogenic environment has been described in euploid fetuses with CHD. However, the underlying pathophysiologic pathway that contributes to CHD in DS remains unknown. The objective was to compare the expression of angiogenic factors and chronic hypoxia genes in heart tissue from DS and euploid fetuses with and without CHD. METHODS The gene expression profile was determined by real-time PCR quantification in heart tissue from 33 fetuses with DS, 23 euploid fetuses with CHD and 23 control fetuses. RESULTS Angiogenic factors mRNA expression was significantly increased in the DS group compared to the controls (soluble fms-like tyrosine kinase-1, 81%, p = 0.007; vascular endothelial growth factor A, 57%, p = 0.006, and placental growth factor, 32%, p = 0.0227). Significant increases in the transcript level of hypoxia-inducible factor-2α and heme oxygenase 1 were also observed in the DS group compared to the controls. The expression of angiogenic factors was similar in DS fetuses and CHD euploid fetuses with CHD. CONCLUSION Abnormal angiogenesis was detected in the hearts of DS fetuses with and without CHD. Our results suggest that DS determines an intrinsically angiogenic impairment that may be present in the fetal heart.
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Affiliation(s)
- Olga Sánchez
- Maternal and Child Health and Development Network II (SAMID II) RD12/0026, Institute of Health Carlos III, Madrid, Spain
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Palomaki GE, Eklund EE, Neveux LM, Lambert Messerlian GM. Evaluating first trimester maternal serum screening combinations for Down syndrome suitable for use with reflexive secondary screening via sequencing of cell free DNA: high detection with low rates of invasive procedures. Prenat Diagn 2015; 35:789-96. [PMID: 25967109 DOI: 10.1002/pd.4609] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 04/22/2015] [Accepted: 04/24/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Examine primary Down syndrome screening using combinations of first trimester serum markers, with and without sequencing of cell free DNA as a secondary reflexive test. METHODS Samples from 40 Down syndrome cases were matched with five control samples and tested for PAPP-A, free β, AFP, inhibin-A and PlGF. Results were converted to weight-adjusted multiples of the median (MoM) and population parameters computed. Monte Carlo simulation modeled Down syndrome detection and false positive rates for various marker combinations. After reflexive DNA testing, the revised detection and false positive rates were also computed. RESULTS At a primary false positive rate of 20%, the baseline combination (maternal age, PAPP-A and free β) detected 86.9%. Adding AFP or PlGF increased detection to 89.8% and 89.5%, respectively. Adding AFP and PlGF, AFP and inhibin-A, or all three markers, detected 93.7%, 94.1% and 95.5%, respectively. Modeling reflexive cf DNA testing results in little loss in detection (1%), but false positive rates fall to 0.2%. CONCLUSION First trimester reflexive testing does not require nuchal translucency measurements, and has high detection and very low rates of invasive procedures. However, timing of DNA sample collection and the costs of sample collection and DNA testing need to be considered before implementation.
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Affiliation(s)
- Glenn E Palomaki
- Division of Medical Screening and Special Testing, Department of Pathology and Laboratory Medicine, Women and Infants Hospital, Providence, RI, USA.,Department of Pathology and Laboratory Medicine, Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Elizabeth E Eklund
- Division of Medical Screening and Special Testing, Department of Pathology and Laboratory Medicine, Women and Infants Hospital, Providence, RI, USA
| | - Louis M Neveux
- Division of Medical Screening and Special Testing, Department of Pathology and Laboratory Medicine, Women and Infants Hospital, Providence, RI, USA
| | - Geralyn M Lambert Messerlian
- Division of Medical Screening and Special Testing, Department of Pathology and Laboratory Medicine, Women and Infants Hospital, Providence, RI, USA.,Department of Pathology and Laboratory Medicine, Alpert School of Medicine, Brown University, Providence, RI, USA
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15
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Huang T, Dennis A, Meschino WS, Rashid S, Mak-Tam E, Cuckle H. First trimester screening for Down syndrome using nuchal translucency, maternal serum pregnancy-associated plasma protein A, free-β human chorionic gonadotrophin, placental growth factor, and α-fetoprotein. Prenat Diagn 2015; 35:709-16. [DOI: 10.1002/pd.4597] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 02/25/2015] [Accepted: 03/26/2015] [Indexed: 12/22/2022]
Affiliation(s)
- Tianhua Huang
- Genetics Program; North York General Hospital; Toronto Ontario Canada
| | - Alan Dennis
- Genetics Program; North York General Hospital; Toronto Ontario Canada
| | - Wendy S. Meschino
- Genetics Program; North York General Hospital; Toronto Ontario Canada
- Department of Paediatrics; University of Toronto; Toronto Ontario Canada
| | - Shamim Rashid
- Genetics Program; North York General Hospital; Toronto Ontario Canada
| | - Ellen Mak-Tam
- Genetics Program; North York General Hospital; Toronto Ontario Canada
| | - Howard Cuckle
- Department of Obstetrics and Gynecology; Columbia University Medical Center; New York NY USA
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16
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Tsiakkas A, Duvdevani N, Wright A, Wright D, Nicolaides KH. Serum placental growth factor in the three trimesters of pregnancy: effects of maternal characteristics and medical history. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 45:591-598. [PMID: 25653039 DOI: 10.1002/uog.14811] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 01/29/2015] [Accepted: 01/29/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To define the contribution of maternal variables which influence the measured level of maternal serum placental growth factor (PlGF) in screening for pregnancy complications. METHODS Maternal characteristics and medical history were recorded and serum levels of PlGF were measured in women with a singleton pregnancy attending for three routine hospital visits at 11 + 0 to 13 + 6, 19 + 0 to 24 + 6 and 30 + 0 to 34 + 6 or 35 + 0 to 37 + 6 weeks' gestation. For women delivering phenotypically normal live births or stillbirths ≥ 24 weeks' gestation, variables from maternal demographic characteristics and medical history important in the prediction of PlGF were determined from a linear mixed-effects multiple regression. RESULTS Serum levels of PlGF were measured in 38,002 cases in the first trimester, 10,281 in the second trimester and 12,392 in the third trimester. Significant independent contributions to serum PlGF were provided by gestational age, maternal age, weight and racial origin, cigarette smoking, diabetes mellitus, and gestational age at delivery and birth-weight Z-score of the neonate in the previous pregnancy. The machine used to measure serum PlGF was also found to have a significant effect. Allowing for other factors, the effect of maternal age on PlGF changed over the three trimesters, whereas other variables had constant effects over the three trimesters. Random-effects multiple regression analysis was used to define the contribution of maternal variables that influence the measured serum PlGF and express the values as multiples of the median (MoMs). The model was shown to provide an adequate fit of MoM values for all covariates, both in pregnancies that developed pre-eclampsia and in those without this complication. CONCLUSIONS A model was fitted to express the measured level of maternal serum PlGF across the three trimesters of pregnancy as MoMs, after adjusting for variables of maternal characteristics and medical history that affect this measurement.
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Affiliation(s)
- A Tsiakkas
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
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17
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Pennings JLA, Siljee JE, Imholz S, Kuc S, de Vries A, Schielen PCJI, Rodenburg W. Comparison of different blood collection, sample matrix, and immunoassay methods in a prenatal screening setting. DISEASE MARKERS 2014; 2014:509821. [PMID: 25132703 PMCID: PMC4123521 DOI: 10.1155/2014/509821] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 07/04/2014] [Indexed: 11/17/2022]
Abstract
We compared how measurements of pregnancy-associated plasma protein A (PAPP-A) and the free beta subunit of human chorionic gonadotropin (fβ-hCG) in maternal blood are influenced by different methods for blood collection, sample matrix, and immunoassay platform. Serum and dried blood spots (DBS) were obtained by venipuncture and by finger prick of 19 pregnant women. PAPP-A and fβ-hCG from serum and from DBS were measured by conventional indirect immunoassay on an AutoDELFIA platform and by antibody microarray. We compared methods based on the recoveries for both markers as well as marker levels correlations across samples. All method comparisons showed high correlations for both marker concentrations. Recovery levels of PAPP-A from DBS were 30% lower, while those of fβ-hCG from DBS were 50% higher compared to conventional venipuncture serum. The recoveries were not affected by blood collection or immunoassay method. The high correlation coefficients for both markers indicate that DBS from finger prick can be used reliably in a prenatal screening setting, as a less costly and minimally invasive alternative for venipuncture serum, with great logistical advantages. Additionally, the use of antibody arrays will allow for extending the number of first trimester screening markers on maternal and fetal health.
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Affiliation(s)
- Jeroen L. A. Pennings
- Centre for Health Protection (GZB), National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA Bilthoven, The Netherlands
| | - Jacqueline E. Siljee
- Centre for Infectious Diseases Research, Diagnostics and Screening (IDS), National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA Bilthoven, The Netherlands
| | - Sandra Imholz
- Centre for Health Protection (GZB), National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA Bilthoven, The Netherlands
| | - Sylwia Kuc
- Centre for Infectious Diseases Research, Diagnostics and Screening (IDS), National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA Bilthoven, The Netherlands
- Department of Obstetrics, Wilhelmina Children's Hospital, University Medical Centre Utrecht (UMCU), P.O. Box 85090, 3508 AB Utrecht, The Netherlands
| | - Annemieke de Vries
- Centre for Health Protection (GZB), National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA Bilthoven, The Netherlands
| | - Peter C. J. I. Schielen
- Centre for Infectious Diseases Research, Diagnostics and Screening (IDS), National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA Bilthoven, The Netherlands
| | - Wendy Rodenburg
- Centre for Health Protection (GZB), National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA Bilthoven, The Netherlands
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18
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Nucci M, Poon LC, Demirdjian G, Darbouret B, Nicolaides KH. Maternal serum placental growth factor (PlGF) isoforms 1 and 2 at 11-13 weeks' gestation in normal and pathological pregnancies. Fetal Diagn Ther 2014; 36:106-16. [PMID: 24457972 DOI: 10.1159/000357842] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 11/28/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare the maternal serum concentration of placental growth factor-1 (PlGF-1) and PlGF-2 at 11-13 weeks' gestation in normal pregnancies and in those complicated by preeclampsia (PE), delivery of small for gestational age (SGA) neonates and fetal trisomies 21, 18 and 13. METHODS Serum PlGF-1 and PlGF-2 were measured in 270 pathological pregnancies (PE, n = 80; SGA, n = 80; trisomy 21, n = 44; trisomy 18, n = 38; trisomy 13, n = 28) and 590 normal controls. The values were expressed as multiple of the median (MoM) after adjustment for maternal characteristics and corrected for adverse pregnancy outcomes and the median MoM values in each pathological pregnancy were compared to the normal group. RESULTS There were significant contributions to PlGF-1 and PlGF-2 from gestational age, smoking and racial origin. In addition, there were significant contributions to PlGF-1 from parity and method of conception. The median MoM of PlGF-1 and PlGF-2 was significantly decreased in PE (0.783 and 0.916 MoM), SGA (0.891 and 0.851 MoM), trisomy 21 (0.609 and 0.749 MoM), trisomy 18 (0.529 and 0.730 MoM) and trisomy 13 (0.373 and 0.699 MoM). CONCLUSIONS In pathological pregnancies, except SGA, the decrease in serum PlGF-1 at 11-13 weeks' gestation is more marked than the decrease in PlGF-2.
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Affiliation(s)
- Marta Nucci
- Harris Birthright Research Centre of Fetal Medicine, King's College Hospital, London, UK
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19
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Cowans NJ, Spencer K. First trimester maternal serum placental growth factor levels in twin pregnancies. Prenat Diagn 2013; 33:1260-3. [PMID: 24114956 DOI: 10.1002/pd.4243] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 09/12/2013] [Accepted: 09/21/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND An understanding of the normal behavior of biochemical markers in twin pregnancies is necessary in order to offer prenatal screening to this subgroup. This study investigates the levels of first trimester maternal serum placental growth factor (PlGF) in twin and singleton pregnancies. METHODS The PlGF concentrations were measured by an automated assay in the first trimester maternal serum of 440 dichorionic twin, 116 monochorionic twin, and 607 singleton pregnancy samples thawed from frozen storage. RESULTS The PlGF concentrations in singleton levels were predicted by gestational age, maternal ethnicity, and smoking status. Following the correction for these variables, PlGF levels were, on average, 41% higher in dichorionics, but only 16% higher in monochorionics, compared to singleton pregnancies. CONCLUSIONS First trimester maternal serum PlGF levels are increased in twin pregnancies compared with singleton pregnancies, but to less of an extent than is common with other screening markers, especially in monochorionic twins.
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Affiliation(s)
- Nicholas J Cowans
- Prenatal Research Unit, Department of Clinical Biochemistry, King George Hospital, Goodmayes, UK
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20
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Johnson J, Pastuck M, Metcalfe A, Connors G, Krause R, Wilson D, Cuckle H. First-trimester Down syndrome screening using additional serum markers with and without nuchal translucency and cell-free DNA. Prenat Diagn 2013; 33:1044-9. [DOI: 10.1002/pd.4194] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 06/21/2013] [Accepted: 07/02/2013] [Indexed: 12/12/2022]
Affiliation(s)
- J Johnson
- Obstetrics and Gynecology; University of Calgary; Calgary AB Canada
| | - M Pastuck
- Coordinator, Early Risk Assessment Program; Calgary AB Canada
| | - A Metcalfe
- Obstetrics and Gynecology; University of British Columbia; Vancouver BC Canada
| | - G Connors
- Obstetrics and Gynecology; University of Calgary; Calgary AB Canada
| | - R Krause
- Calgary Laboratory Services; Calgary AB Canada
| | - D Wilson
- Obstetrics and Gynecology; University of Calgary; Calgary AB Canada
| | - H Cuckle
- Obstetrics and Gynecology; Columbia University Medical Center; New York NY USA
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21
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Donalson K, Turner S, Morrison L, Liitti P, Nilsson C, Cuckle H. Maternal serum placental growth factor and α
-fetoprotein testing in first trimester screening for Down syndrome. Prenat Diagn 2013; 33:457-61. [DOI: 10.1002/pd.4087] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Kim Donalson
- Biochemistry Department; Royal Victoria Infirmary; Newcastle UK
| | - Steve Turner
- Biochemistry Department; Royal Victoria Infirmary; Newcastle UK
| | - Lesley Morrison
- Biochemistry Department; Royal Victoria Infirmary; Newcastle UK
| | - Päivi Liitti
- Wallac Oy; a subsidiary of PerkinElmer Inc; Turku Finland
| | | | - Howard Cuckle
- Obstetrics & Gynecology; Medical College of Columbia University; New York USA
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22
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Kagan KO, Hoopmann M, Abele H, Alkier R, Lüthgens K. First-trimester combined screening for trisomy 21 with different combinations of placental growth factor, free β-human chorionic gonadotropin and pregnancy-associated plasma protein-A. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 40:530-535. [PMID: 22611005 DOI: 10.1002/uog.11173] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/30/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To examine placental growth factor (PlGF) in euploid and trisomy 21 pregnancies at 11-13 weeks' gestation and to model the impact on first-trimester combined screening. METHODS PlGF was measured in 509 (409 euploid and 100 trisomic) fetal serum samples derived from prospective first-trimester combined screening for trisomy 21 at 11-13 weeks' gestation. The serum samples were stored at -80°C, following the measurement of free β-human chorionic gonadotropin (β-hCG) and pregnancy-associated plasma protein-A (PAPP-A) levels, for median time spans of 0.9 and 4.1 years in the euploid and trisomy 21 pregnancies, respectively. The effect of additional PlGF measurement at the time of combined screening was investigated by simulating fetal nuchal translucency (NT) measurements and multiples of the median (MoM) values for PAPP-A, free β-hCG and PlGF for 20,000 euploid and 20,000 trisomy 21 pregnancies. Patient-specific combined risks were calculated based on maternal age and fetal NT in addition to free β-hCG, PAPP-A and PlGF, PAPP-A and PlGF or free β-hCG and PlGF, and detection and false-positive rates were calculated. RESULTS Median PlGF-MoM was 1.0 (95% confidence interval (CI), 0.96-1.04) in euploid fetuses and significantly lower, at 0.73 (95% CI, 0.70-0.76), in trisomy-21 fetuses (P < 0.0001). There was no significant dependency between PlGF-MoM and either gestational age at the time of blood sampling (r = 0.087, P = 0.392) or sample storage time (r = 0.028, P = 0.785). Modeled detection and false-positive rates for first-trimester combined screening (based on maternal and gestational age, fetal NT and maternal serum biochemistry) without PlGF were 85% and 2.7% for a fixed risk cut-off of 1:100. The addition of PlGF increased the detection rate to 87% and reduced the false-positive rate to 2.6%. Screening by maternal age and fetal NT in combination with PlGF and PAPP-A or in combination with PlGF and free β-hCG provided detection rates of 82% and 79%, with false-positive rates of 2.7% and 3.0%, respectively. CONCLUSION In pregnancies with trisomy 21 PlGF is reduced. The impact on the overall screening performance for trisomy 21 is low and does not justify the measurement of PlGF solely for trisomy 21 screening. However, as PlGF is measured with the aim of assessing the risk for pre-eclampsia, further improvement in screening for trisomy 21 can be considered as an added benefit.
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Affiliation(s)
- K O Kagan
- Department of Obstetrics and Gynecology, University of Tuebingen, Tuebingen, Germany.
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Antenatal screening for Down syndrome using serum placental growth factor with the combined, quadruple, serum integrated and integrated tests. PLoS One 2012; 7:e46955. [PMID: 23056541 PMCID: PMC3463523 DOI: 10.1371/journal.pone.0046955] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 09/07/2012] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To estimate the value of first or second trimester placental growth factor (PlGF) as an additional antenatal screening marker for Down syndrome. DESIGN Nested case-control study. SETTING Antenatal screening service. POPULATION OR SAMPLE 532 Down syndrome pregnancies and 1,155 matched unaffected pregnancies. METHODS Stored maternal serum samples (-40°C) were assayed for PlGF. Monte Carlo simulation was used to estimate the screening performance of PlGF with the Combined, Quadruple, serum Integrated and Integrated tests. MAIN OUTCOME MEASURES Median PlGF levels in affected and unaffected pregnancies and screening performance (detection rates [DR] for specified false-positive rates [FPR] and vice versa). RESULTS First trimester median PlGF was 15%, 28% and 39% lower in Down syndrome than unaffected pregnancies at 11, 12 and 13 completed weeks' gestation respectively (all p<0.001). Second trimester median PlGF was 31% lower at 14 weeks (p<0.001), and the difference decreased (6% lower at 17 weeks). At a 90% DR with first trimester markers measured at 13 weeks, adding PlGF decreased the FPR from 11.1 to 5.1% using the Combined test, 9.3% to 4.5% using the serum Integrated test, and 3.4% to 1.5% using the Integrated test (or 1.5 to 1.4% with first trimester markers measured at 11 weeks). Adding PlGF to the Quadruple test (measured at 15 weeks) decreased the FPR from 10.0% to 9.6% at a 90% DR. CONCLUSIONS First trimester PlGF measurements improve the performance of antenatal screening for Down syndrome using the Combined, serum Integrated and Integrated tests. Second trimester PlGF measurements are of limited value.
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Cowans NJ, Kisanga MC, Spencer K. Maternal serum placental growth factor in second trimester trisomy 21 pregnancies. Prenat Diagn 2012; 32:117-21. [PMID: 22418953 DOI: 10.1002/pd.2904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate the levels of placental growth factor (PlGF) in second trimester maternal serum in trisomy 21 cases and euploid controls - an unclear subject in the published literature. METHODS Second trimester maternal serum samples from 17 recent (since 2005) and 74 older trisomy 21 cases and 542 euploid controls were extracted from frozen storage and retrospectively analysed for PlGF using a DELFIA Xpress immunoassay platform. Results were converted to multiples of median (MoM) for comparison. RESULTS The control group had a PlGF MoM of 0.99, the recent trisomy 21 cases had a PlGF MoM of 1.13 and the older cases a PlGF MoM of 1.11; however, the differences between trisomy 21 cases and controls were not significant. CONCLUSION Although we have found no significant change in the second trimester levels of PlGF in trisomy 21 pregnancies, there remains wide disagreement within the literature on the behaviour of this marker during pregnancies of this syndrome.
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Affiliation(s)
- N J Cowans
- Prenatal Screening Unit, Department of Clinical Biochemistry, King George Hospital, Barley Lane, Goodmayes, Essex, United Kingdom
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Pandya P, Wright D, Syngelaki A, Akolekar R, Nicolaides KH. Maternal Serum Placental Growth Factor in Prospective Screening for Aneuploidies at 8–13 Weeks’ Gestation. Fetal Diagn Ther 2012; 31:87-93. [DOI: 10.1159/000335684] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 12/11/2011] [Indexed: 11/19/2022]
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Koster MPH, Wortelboer EJ, Stoutenbeek P, Visser GHA, Schielen PCJI. Modeling Down syndrome screening performance using first-trimester serum markers. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 38:134-139. [PMID: 21800388 DOI: 10.1002/uog.8881] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To evaluate the modeled predictive value of three current screening markers (pregnancy-associated plasma protein-A (PAPP-A), free β-human chorionic gonadotropin (free β-hCG), and nuchal translucency (NT)) and four potential screening markers (a disintegrin and metalloprotease 12 (ADAM12), total hCG, placental protein 13 (PP13), and placental growth factor (PlGF)) for Down syndrome using different screening strategies. METHODS All markers were measured in stored first-trimester serum of 151 Down syndrome cases and 847 controls. All marker levels were expressed as gestational age-specific multiples of the median (MoMs) and comparisons were made using the Mann-Whitney U-test. Detection rates (DRs) for fixed false-positive rates (FPRs) were modeled using different screening strategies. RESULTS Significantly different median MoMs for Down syndrome cases compared to controls were found for PAPP-A (0.49 vs. 1.00; P < 0.0001), free β-hCG (1.70 vs. 1.01; P < 0.0001), ADAM12 (0.89 vs. 1.00; P < 0.0001), total hCG (1.28 vs. 1.00; P < 0.0001), PlGF (0.80 vs. 1.00; P < 0.0001) and NT (1.74 vs. 1.01; P < 0.0001). The lower PP13 MoM in Down syndrome cases (0.91 vs. 1.00) was not statistically significant (P = 0.061). Adding the four new markers to the current screening strategy (i.e. first-trimester combined test) led to an increase in DR from 77% to 80% at a 5% FPR. The modeled application of a two-sample screening strategy (with some markers assessed early and others later in the first trimester) increased the DR to 89%. In a two-step contingent screening model, using an intermediate risk range of 1 in 100 to 1 in 2000 at biochemical screening (using all markers), the overall DR was 77%, but it was predicted that only 33% of women would require referral for NT measurement. CONCLUSIONS First-trimester Down syndrome screening may be improved by adding new markers to the current screening test and by applying different screening strategies. The application of a two-sample screening model resulted in the highest predicted DR, but this should be confirmed in population-based prospective studies.
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Affiliation(s)
- M P H Koster
- Laboratory for Infectious Diseases and Screening, National Institute for Public Health and Environment (RIVM), Bilthoven, The Netherlands.
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Cuckle HS. Screening for pre-eclampsia--lessons from aneuploidy screening. Placenta 2011; 32 Suppl:S42-8. [PMID: 21257082 DOI: 10.1016/j.placenta.2010.07.015] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 07/26/2010] [Accepted: 07/28/2010] [Indexed: 01/14/2023]
Abstract
BACKGROUND Antenatal screening for aneuploidy is an established routine clinical practice worldwide. The same statistical methodology, developed and refined over three decades, might be adapted to screening for pre-eclampsia. METHODS The published literature is reviewed for evidence that the methodology is valid for pre-eclampsia using first trimester maternal serum PP13, PAPP-A, PlGF, ADAM12 and inhibin A, together with MAP and uterine artery Doppler PI. Risk is estimated for both early onset pre-eclampsia, requiring delivery before 34 weeks, or late onset disease. Prior risk from the background prevalence multiplied by likelihood ratios (LRs) for ethnicity, parity, adiposity and family history is multiplied by an LR from the screening marker profile. Markers are expressed in multiples of the gestation-specific median and adjusted for body mass, ethnicity and smoking status as appropriate. A standardized population with a fixed distribution of risk factors and a multi-variate Gaussian model of marker profiles is used to predict performance. RESULTS There is sufficient published data to estimate individual risks reasonably well. Modeling predicts that using PAPP-A and one other serum marker, together with the physical markers more than two-thirds of early and one-third of late onset cases can be detected by classifying less than 2% of pregnancies as high risk; three-quarters of early case could be detected with a 5% high risk rate. CONCLUSION Whilst more data on some markers is still required modeling so far suggests that extending first trimester aneuploidy screening programs to include pre-eclampsia screening would yield a high detection. However, prospective studies are needed to verify the model predictions.
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Affiliation(s)
- H S Cuckle
- Department of Obsterics and Gynecology, Columbia University Medical Center, 622 W. 168th Street, PH1666, New York, NY 10032, USA.
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Cowans NJ, Stamatopoulou A, Tørring N, Spencer K. Early first-trimester maternal serum placental growth factor in trisomy 21 pregnancies. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 37:515-519. [PMID: 21105022 DOI: 10.1002/uog.8890] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/09/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVES To measure maternal serum placental growth factor (PlGF) levels in trisomy 21 cases and controls in samples drawn before 11 weeks' gestation. METHODS Early first-trimester maternal serum samples, drawn between 8 + 0 and 10 + 6 weeks' gestation, for 37 trisomy 21 cases and 244 unaffected controls were retrieved from frozen storage, and PlGF was retrospectively measured using a DELFIA Xpress immunoassay platform. PlGF levels were converted to multiples of the median (MoM), and trisomy 21 and unaffected groups were compared. RESULTS Raw PlGF and MoM levels were significantly higher in the maternal serum of trisomy 21 cases than in controls over the 3-week gestational window (unaffected 1.0 MoM compared with trisomy 21 1.3 MoM (P < 0.0001)). However at 8 completed weeks of gestation the increase was most significant and at 10 completed weeks there was no significant difference between trisomy 21 and unaffected PlGF levels. CONCLUSIONS Early PlGF levels in maternal serum in trisomy 21 cases may be increased relative to unaffected controls, however, the relationship between PlGF levels and gestational age in trisomy 21 and unaffected pregnancies in the first two trimesters of pregnancy appears to be complex and requires further study.
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Affiliation(s)
- N J Cowans
- Prenatal Screening Unit, Department of Clinical Biochemistry, King George Hospital, Goodmayes, UK
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Cowans NJ, Stamatopoulou A, Spencer K. First trimester maternal serum placental growth factor in trisomy 21 pregnancies. Prenat Diagn 2010; 30:449-53. [PMID: 20301202 DOI: 10.1002/pd.2496] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine placental growth factor (PlGF) levels in first trimester maternal serum in trisomy 21 pregnancies and to investigate the potential value of PlGF in a first trimester screening test. METHODS First trimester maternal serum from 70 trisomy 21 cases and 375 euploid controls were retrospectively analyzed for PlGF using a DELFIA Xpress immunoassay platform. Results were expressed as multiples of medians (MoM) for comparison. RESULTS PlGF levels were significantly decreased in pregnancies with trisomy 21, 0.76 MoM versus 0.98 MoM in controls. Inclusion of PlGF into the first trimester combined test [maternal age, pregnancy associated plasma protein-A (PAPP-A), free-beta human chorionic gonadotrophin (beta-hCG) and nuchal translucency] would increase the detection rate by 0.5% at a 5% false positive rate. CONCLUSION PlGF at 11 weeks to 13 weeks 6 days has the potential to be included as a marker for the detection of pregnancies with trisomy 21.
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Affiliation(s)
- N J Cowans
- Prenatal Research Unit, Clinical Biochemistry Department, King George Hospital, Goodmayes, UK
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Chen CP. Prenatal sonographic features of fetuses in trisomy 13 pregnancies. IV. Taiwan J Obstet Gynecol 2010; 49:3-12. [PMID: 20466286 DOI: 10.1016/s1028-4559(10)60002-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2009] [Indexed: 10/19/2022] Open
Abstract
Prenatal ultrasound is a powerful tool to detect structural abnormalities associated with the fetuses in trisomy 13 pregnancies. This article provides a comprehensive review of the prenatal sonographic markers of trisomy 13 in the first trimester, including fetal nuchal translucency thickness, fetal heart rate, fetal nasal bone, fetal tricuspid regurgitation, ductus venous flow, fetal crown-rump length, fetal trunk and head volume, fetal frontomaxillary facial angle, gestational sac volume and umbilical cord diameter, along with biochemical markers such as maternal serum free beta-human chorionic gonadotropin, maternal serum pregnancy-associated plasma protein-A, maternal serum placental growth factor, and the fetal and total cell-free DNA concentration in the maternal circulation.
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Affiliation(s)
- Chih-Ping Chen
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan.
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Koster MPHW, Heetkamp KM, Pennings JLA, de Vries A, Visser GHA, Schielen PCJI. Down syndrome screening: imagining the screening test of the future. Expert Rev Mol Diagn 2010; 10:445-57. [PMID: 20465499 DOI: 10.1586/erm.10.32] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Prenatal screening for Down syndrome (DS) is performed by risk calculation based on biochemical and biometric parameters. This way, approximately 75-85% of all DS cases can be detected. A way to improve detection rates is to search for new screening markers. Since the majority of biomarkers used in current DS screening are predominantly produced by the placenta, and the presence of an extra chromosome (as in DS) complicates placental development and function, it is plausible to assume that new potential screening markers may also originate from the placenta. Any alterations in these markers can be attributed to abnormal placental development and function. This article focuses on normal early placental development and function compared with that in DS pregnancies. Using this knowledge, we reason towards candidate biomarkers that may be useful in screening for DS.
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Affiliation(s)
- M P H Wendy Koster
- National Institute for Public Health and the Environment (RIVM), PO Box 1, NL-3720BA Bilthoven, The Netherlands.
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Koster MPH, Stoutenbeek P, Visser GHA, Schielen PCJI. Trisomy 18 and 13 screening: consequences for the Dutch Down syndrome screening programme. Prenat Diagn 2010; 30:287-9. [PMID: 20112231 DOI: 10.1002/pd.2467] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Poon LC, Kametas NA, Maiz N, Akolekar R, Nicolaides KH. First-Trimester Prediction of Hypertensive Disorders in Pregnancy. Hypertension 2009; 53:812-8. [DOI: 10.1161/hypertensionaha.108.127977] [Citation(s) in RCA: 331] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Leona C.Y. Poon
- From the Harris Birthright Research Centre for Fetal Medicine, King’s College Hospital, London, United Kingdom
| | - Nikos A. Kametas
- From the Harris Birthright Research Centre for Fetal Medicine, King’s College Hospital, London, United Kingdom
| | - Nerea Maiz
- From the Harris Birthright Research Centre for Fetal Medicine, King’s College Hospital, London, United Kingdom
| | - Ranjit Akolekar
- From the Harris Birthright Research Centre for Fetal Medicine, King’s College Hospital, London, United Kingdom
| | - Kypros H. Nicolaides
- From the Harris Birthright Research Centre for Fetal Medicine, King’s College Hospital, London, United Kingdom
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