Early detection of maternal risk for preeclampsia

Serum macrophage stimulating protein α-chain and uterine artery Doppler ultrasound in the first trimester for the prediction of preeclampsia

To assess how effective macrophage stimulating protein α-chain (MSP-α) combined with uterine artery Doppler is in predicting preeclampsia in singleton pregnancies during 11-13+6 weeks of gestation. This prospective observational study included singleton pregnant women who attended antenatal care at King Chulalongkorn Memorial Hospital, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University between December 2021 and April 2023, during 11-13+6 weeks of gestation. Serum MSP-α levels were collected and uterine artery Doppler ultrasound was performed. Pregnancy outcomes were recorded, and the predictive values of these tests were determined to predict preeclampsia. A total of 365 patients, with 21 cases of preeclampsia (5.8%), were analyzed. Serum MSP-α levels were higher in pregnant women who developed preeclampsia than those who did not (899.7 ± 550.1 ng/ml vs 642.5 ± 466.1 ng/ml, p = 0.016). The mean pulsatility index of the uterine artery and the presence of diastolic notching were not significantly different between the groups. As a cut-off value for predicting preeclampsia, using serum MSP-α levels higher than 1.0 multiple of median for gestational age, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 71.4%, 50.3%, 8.1%, and 96.7%, respectively. Additionally, when abnormal serum MSP-α levels were combined with a uterine artery Doppler pulsatility index above the 95th percentile and bilateral notching as predictive values for preeclampsia, the sensitivity was 85.7%, specificity was 18.3%, PPV was 6.0%, and NPV was 95.5%. Serum MSP-α alone at 11-13+6 weeks of gestation was effective in predicting preeclampsia. However, the use of serum MSP-α in combination with uterine artery Doppler increased sensitivity but reduced specificity for the prediction of preeclampsia.

Diagnostic Accuracy of Serum Glycosylated Fibronectin in Prediction of Preeclampsia: A Nested Case-Control Study

BACKGROUND

Preeclampsia is a life-threatening complication of pregnancy that occurs in approximately 7% of all pregnancies. In India, the incidence of preeclampsia is 8%-10% and the prevalence is 5.4%, whereas the prevalence of hypertensive disorders of pregnancy is 7.8%.

AIM AND OBJECTIVES

This study was aimed at evaluating the diagnostic accuracy of serum glycosylated fibronectin (S. GlyFn) in the prediction of preeclampsia.

METHODS

A nested case-control study was carried out for 16 months in the department of obstetrics and gynecology. A total of 240 women were recruited and followed after written consent and ethical clearance. Six were lost to follow-up, 15 had second-trimester abortions (excluded from the study), and 32 women developed hypertensive disorders of pregnancy (cases), out of which 1 woman developed antepartum eclampsia, 10 women developed preeclampsia with severe features, and 21 women developed preeclampsia without severe features. One hundred and eighty-seven women remained normotensive throughout the pregnancy until 6 weeks postpartum. After randomization, out of these samples, 54 were analyzed and considered controls. Levels of S. GlyFn were estimated using an ELISA kit using the ELISA technique.

RESULTS

The mean S. GlyFn level was significantly higher at the time of enrollment among those women who later developed preeclampsia (127.59 ± 27.68 ng/m) as compared to controls (107.79-53.51 ng/mL). GlyFn at a cutoff value of 126.70 ng/mL significantly (P = 0.034) discriminates cases of preeclampsia with severe features from healthy controls with a sensitivity of 90.00%, a specificity of 63.00%, a 31.03% positive predictive value, and 97.14% negative predictive value.

CONCLUSION

S. GlyFn, at a cutoff value of 126.70 ng/mL, had good sensitivity to discriminate PE from normotensive and was also a good prognostic marker.

The value of eosinophil count in the diagnosis of preeclampsia among pregnant women attending the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2021

BACKGROUND

Currently, studies showed that eosinophil count had clinical significance in the diagnosis and prognosis of diseases. But, the clinical significance of eosinophil count in pregnancy specifically in preeclampsia (PE) is not well studied. The main objective of the present study was to assess the diagnosis value of eosinophils counts among pregnant women with PE.

METHODS

A comparative cross-sectional study was conducted on a total of 126 pregnant women at the University of Gondar Comprehensive Specialized Hospital, using a convenient sampling technique. Socio-demographic and clinical data were collected by questionnaire and datasheet from patient's charts, respectively. A total of six ml of blood was collected from each study participant; three ml for complete cell count analysis using Sysmex XS-500i hematology analyzer and three ml for liver function tests using Humastar 200 chemistry analyzer. The data were entered into Epi-data and exported to SPSS 20 for analysis. The independent t-test was used for normally distributed data and, the Mann-Whitney U test was used for non-normally distributed data. Binary logistic regression and receiver operative curve analyses were also done to assess the diagnosis value of eosinophils count. P-value < 0.05 was considered statistically significant.

RESULTS

The eosinophils count of PE pregnant women were significantly lower than the normotensive (NT) pregnant women (median (IQR): 50 (10-200) vs. 120 (60 - 270); (p = 0.002). The eosinophil count ≤ 55 cells/µL had an AUC of 0.66 (95% CI; 0.56-0.75) for diagnosis of PE with a sensitivity of 50.8%, specificity of 77.8%, and positive and negative predictive value of 69.6% and 61.3%, respectively. The abnormal AST and ALT results were significantly higher among PE pregnant women compared to NT pregnant women (AOR: 14.86; 95% CI: 4.97-44.4 and Fischer exact test p-value = 0.001, respectively).

CONCLUSION

The eosinophil count ≤ 55cells/µl had a reasonable/acceptable AUC which may use in the diagnosis of PE. AST and ALT were also significantly higher in PE pregnant women compared to NT pregnant women. Multicenter longitudinal studies with a large sample size are recommended to verify the role of eosinophil count in the diagnosis of PE.

Identification and Validation of a Five-Gene Diagnostic Signature for Preeclampsia

Preeclampsia is the leading cause of morbidity and mortality for mothers and newborns worldwide. Despite extensive efforts made to understand the underlying pathology of preeclampsia, there is still no clinically useful effective tool for the early diagnosis of preeclampsia. In this study, we conducted a retrospectively multicenter discover-validation study to develop and validate a novel biomarker for preeclampsia diagnosis. We identified 38 differentially expressed genes (DEGs) involved in preeclampsia in a case-control study by analyzing expression profiles in the discovery cohort. We developed a 5-mRNA signature (termed PE5-signature) to diagnose preeclampsia from 38 DEGs using recursive feature elimination with a random forest supervised classification algorithm, including ENG, KRT80, CEBPA, RDH13 and WASH9P. The PE5-signature showed high accuracy in discriminating preeclampsia from controls with a receiver operating characteristic area under the curve value (AUC) of 0.971, a sensitivity of 0.842 and a specificity of 0.950. The PE5-signature was then validated in an independent case-control study and achieved a reliable and robust predictive performance with an AUC of 0.929, a sensitivity of 0.696, and a specificity of 0.946. In summary, we have developed and validated a five-mRNA biomarker panel as a risk assessment tool to assist in the detection of preeclampsia. This gene panel has potential clinical value for early preeclampsia diagnosis and may help us better understand the precise mechanisms involved.

The role of platelet parameters for the diagnosis of preeclampsia among pregnant women attending at the University of Gondar Comprehensive Specialized Hospital antenatal care unit, Gondar, Ethiopia

Background

Preeclampsia (PE) is a pregnancy‐related illness characterized by high blood pressure (BP) and proteinuria after the 20th gestational week (GW). Platelet (PLT) parameter changes are the common hematological abnormalities observed in PE patients. The main aim of this study was to assess the role of PLT parameters for PE diagnosis among pregnant women.

Methods

A comparative cross‐sectional study was conducted at the University of Gondar Specialized Hospital. A total of 126 pregnant women (63 normotensive [NT] and 63 PE) were recruited using a convenient sampling method. Three milliliter blood was collected from each participant, and PLT parameters were determined using Sysmex XS‐500i analyzer. An independent t‐test supplemented with receiver‐operating characteristics (ROC) were used for comparisons and diagnostic value of PLT parameters between the study groups.

Results

Platelet count (PC) was significantly lower in the PE group compared to that in the NT group, whereas mean platelet volume (MPV), platelet large cell ratio (P‐LCR), and platelet distribution width (PDW) were significantly higher in PE. MPV had the largest area under the curve (AUC) [0.91: 95% CI; 0.85–0.96] followed by PC [0.79: 95% CI; 0.72–0.87]. MPV can differentiate PE patients from NT pregnant women at cut‐off value ≥12.10 fl (84.1% sensitivity and 87.3% specificity) while PC can indicate PE at a cut‐off value ≤176.5 × 10⁹/L (65.1% sensitivity and 87.3% specificity).

Conclusion

A decreased PC and an increased MPV, P‐LCR, and PDW can be used as a simple, cost‐effective, quick, and reliable method of PE screening. Of them, MPV is the best indicator of PE.

Serum SHARP1 and uterine artery Doppler for the prediction of preeclampsia

The aim of this study was to identify the value of serum SHARP1 levels and Doppler of the uterine artery in singleton pregnancy at 11–13⁺⁶ weeks for predicting preeclampsia. A prospective observational study was conducted in pregnant women at 11–13⁺⁶ weeks of pregnancy who had antenatal care at King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand, between January 2017 and January 2018. Serum SHARP1 measurement and transabdominal Doppler of the uterine artery were performed. The predictive values of these tests were determined. Data were obtained from 405 pregnant women. Thirty-five women had preeclampsia (8.6%), and six of these had early-onset preeclampsia (1.5%). Preeclamptic women had significantly lower serum SHARP1 levels than pregnant women without preeclampsia (3.6 ng/ml vs 4.7 ng/ml, p < 0.01). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of serum SHARP1 levels of less than 3.89 ng/ml for predicting preeclampsia were 77.1%, 72.7%, 21.1% and 97.1%, respectively. For uterine artery Doppler, the sensitivity, specificity, PPV and NPV of the mean pulsatility index (PI) > 95^th percentile for predicting preeclampsia were 5.7%, 95.4%, 10.5% and 91.5%, respectively. For the combination of serum SHARP1 levels with a cutoff value of less than 3.89 ng/ml and a mean PI > 95^th percentile, the sensitivity, specificity, PPV and NPV were 77.1%, 70.3%, 19.7% and 97.0%, respectively. This study demonstrated that serum SHARP1 is a promising biomarker for predicting preeclampsia in the first trimester.

Evaluation of Serum Biomarkers and Other Diagnostic Modalities for Early Diagnosis of Preeclampsia

Objective: Preeclampsia (PE) is a multi-systemic complication of pregnancy often characterised with the onset of hypertension and proteinuria after 20 weeks of gestation. Today, PE is the leading cause of maternal and perinatal morbidity and mortality worldwide. An early detection of PE would allow a chance to plan the appropriate monitoring and for clinical management to be immediately done following early detection thus making prophylactic strategies much more effective. Materials and methods: This systematic review aims to evaluate the potential of the various serum biomarkers and diagnostic modalities (uterine artery Doppler, MAP, and maternal history) available for early prediction of PE with articles included and obtained through MEDLINE Full Text, Pubmed, Science Direct, ProQuest, SAGE, Taylor and Francis Online, Google Scholar, HighWire and Elsevier ClinicalKey. Results: Ninety-five articles were found that fulfilled all of our inclusion criteria. Placental growth factor (PlGF), pregnancy associated plasma protein A (PAPP-A), soluble fms-like tyrosine kinase (sFLT) and placental protein 13 (PP-13) were the most commonly studied biomarkers. Whereas uterine Doppler scanning and Mean Arterial Pressure (MAP) were the most commonly studied out of other modalities. Conclusion: Current evidence shows serum biomarkers such as PIGF, PP-13 and sFlt yielded the best results for a single biomarker with others having conflicting results. However, a combination model with other diagnostic modalities performed better than a single biomarker. In the future, new techniques will hopefully provide sets of multiple markers, which will lead to a screening program with clinically relevant performance. However further studies are required to improve current methods.

Delayed hemolysis, elevated liver enzymes, low platelet count syndrome in succession of switches of preventive anticoagulant treatment in a 41-year-old patient with a history of recurrent assisted implantation failures: a case report

Background

For the past decades the mean age of primiparae in Western societies is constantly increasing. At the same time, there is a growing demand for assisted reproductive technologies such as in vitro fertilization and intracytoplasmic sperm injection. Subsequently, a higher prevalence of pregnancy-associated diseases such as gestational hypertension and preeclampsia is observed. To improve pregnancy rates after in vitro fertilization/intracytoplasmic sperm injection and to reduce the risk of pregnancy-associated diseases with a cardiovascular pathophysiology, two anticoagulants are the focus of current research: low molecular weight heparin and acetylsalicylic acid (aspirin).

Case presentation

A 41-year-old white woman, gravida 3, para 0, received low molecular weight heparin to reduce the risk of abortion after five unsuccessful intracytoplasmic sperm injections and two miscarriages. She autonomously discontinued the medication with low molecular weight heparin at 12 weeks and 2 days of gestation and took aspirin instead until 24 weeks and 2 days of gestation as preeclampsia prophylaxis. However, the pregnancy ended with an urgent cesarean section at 27 weeks and 4 days of gestation due to a fast progressing hemolysis, elevated liver enzyme levels, and low blood platelet count syndrome, a potentially life-threatening variant of preeclampsia.

Conclusion

Based on the current demographic trend toward late-in-life pregnancy it is mandatory to establish clear guidelines concerning preventive treatment options of preeclampsia for patients with risk factors. The establishment of a special first-trimester screening for these women should be discussed. Moreover, it is necessary to raise the awareness among physicians of these contemporary issues to guarantee the best possible medical care.

Electronic supplementary material

The online version of this article (10.1186/s13256-018-1943-1) contains supplementary material, which is available to authorized users.

Proteomics Method to Identification of Protein Profiles in Exosomes

Exosomes are membrane-bound nanovesicles that transport molecular signals (e.g., proteins) between cells and are released from a wide range of cells, including the human placenta. Interestingly, the levels of exosomes present in maternal circulation are higher in preeclamptic pregnancies and their protein content profile change in response to the microenvironment milieu. Through the discovery of candidate biomarkers, mass spectrometry (MS)-based proteomics may provide a better understanding of the pathophysiology underlying pregnancy-associated disorders. With advances in sample preparation techniques, computational methodologies, and bioinformatics, MS-based proteomics have addressed the challenge of identifying and quantifying thousands of proteins and peptides from a variety of complex biological samples. Despite increasing interest in biomarker diagnostics, the complex nature of biological matrices (e.g., plasma) poses a challenge for candidate biomarker discovery. Here we describe a workflow to prepare exosomes for proteomic analysis.

Plasma cross-gestational sphingolipidomic analyses reveal potential first trimester biomarkers of preeclampsia

Introduction

Preeclampsia (PE) is a gestational disorder, manifested in the second half of pregnancy by maternal hypertension, proteinuria and generalized edema. PE is a major cause of maternal and fetal morbidity and mortality, accounting for nearly 40% of all premature births worldwide. Bioactive sphingolipids are emerging as key molecules involved in etiopathogenesis of PE, characterized by maternal angiogenic imbalance and symptoms of metabolic syndrome. The aim of this study was to compare the cross-gestational profile of circulating bioactive sphingolipids in maternal plasma from preeclamptic (PE) versus normotensive control (CTL) subjects with the goal of identifying sphingolipids as candidate first trimester biomarkers of PE for early prediction of the disease.

Methods

A prospective cohort of patients was sampled at the first, second and third trimester of pregnancy for each patient (11–14, 22–24, and 32–36 weeks´ gestation). A retrospective stratified study design was used to quantify different classes of sphingolipids in maternal plasma. We used a reverse-phase high-performance liquid chromatography-tandem mass spectrometry (HPLC-ESI-MS/MS) approach for determining different sphingolipid molecular species (sphingosine-1-phosphate (S1P), dihydro-sphingosine-1-phosphate (DH-S1P), sphingomyelins (SM) and ceramides (Cer)) in cross-gestational samples of human plasma from PE (n = 7, 21 plasma samples across pregnancy) and CTL (n = 7, 21 plasma samples across pregnancy) patients.

Results

Plasma levels of angiogenic S1P did not change significantly in control and in preeclamptic patients´ group across gestation. DH-S1P was significantly decreased in second trimester plasma of PE patients in comparison to their first trimester, which could contribute to reduced endothelial barrier observed in PE. The major ceramide species (Cer 16:0 and Cer 24:0) tended to be up-regulated in plasma of control and PE subjects across gestation. The levels of a less abundant plasma ceramide species (Cer 14:0) were significantly lower in first trimester plasma of PE patients when compared with their gestational-matched control samples (p = 0.009). Major plasma sphingomyelin species (SM 16:0, SM 18:1 and SM 24:0) tended to be higher in control pregnancies across gestation. However, in PE patients, SM 16:0, SM 18:0 and SM 18:1 showed significant up-regulation across gestation, pointing to atherogenic properties of the sphingomyelins and particularly the potential contribution of SM 18:0 to the disease development. In addition, two major sphingomyelins, SM 16:0 and SM 18:0, were significantly lower in first trimester plasma of PE patients versus first trimester samples of respective controls (p = 0.007 and p = 0.002, respectively).

Conclusions

Cross-gestational analysis of maternal plasma of preeclamptic and normotensive women identifies differences in the biochemical profile of major sphingolipids (DH-S1P, sphingomyelins and ceramides) between these two groups. In addition, first trimester maternal plasma sphingolipids (Cer 14:0, SM 16:0 and SM 18:0) may serve in the future as early biomarkers of PE occurrence and development.

A Comparison of 2-Methoxyestradiol Value in Women with Severe Preeclampsia Versus Normotensive Pregnancy

INTRODUCTION

Preeclampsia is a pregnancy complication characterized by high blood pressure and proteinuria. Endothelial dysfunction is a major theory suggested as its aetiology. It is caused by anti-angiogenic condition characterized by low Vascular Endothelial Growth Factor (VEGF). An estradiol metabolite, called 2-Methoxy Estradiol (2-ME), is produced with the help of Catechol-O-Methyltransferase (COMT). This substance has an important role in VEGF expression. A 2-ME is suppressed in women with preeclampsia.

AIM

To compare 2-ME in women with severe preeclampsia and normotensive pregnancy.

MATERIALS AND METHODS

A total of 80 subjects qualified the inclusion and exclusion criteria, were divided into two groups (40 each): the severe preeclampsia and the normotensive pregnancy. Blood sample was collected and examined with the ELISA 2-ME kit (Cayman). The data were compared and calculated using Fisher-Exact test to examine 2-ME differences between the two groups.

RESULTS

Women age, parity, and gestational age showed a non significant difference between both groups. Nonetheless, the BMI before pregnancy and the history of preeclampsia in the past pregnancy showed significant differences. In this study, the 2-ME value was lower in the severe preeclampsia group compared to the normotensive.

CONCLUSION

This study concludes that 2-ME value in severe preeclampsia is lower than normotensive pregnancy. A lower 2-ME value may indicate COMT not producing enough 2-ME which in turn may cause the pre-eclampsia.

Absolute Quantification of Uric Acid in Human Urine Using Surface Enhanced Raman Scattering with the Standard Addition Method

High levels of uric acid in urine and serum can be indicative of hypertension and the pregnancy related condition, preeclampsia. We have developed a simple, cost-effective, portable surface enhanced Raman scattering (SERS) approach for the routine analysis of uric acid at clinically relevant levels in urine patient samples. This approach, combined with the standard addition method (SAM), allows for the absolute quantification of uric acid directly in a complex matrix such as that from human urine. Results are highly comparable and in very good agreement with HPLC results, with an average <9% difference in predictions between the two analytical approaches across all samples analyzed, with SERS demonstrating a 60-fold reduction in acquisition time compared with HPLC. For the first time, clinical prepreeclampsia patient samples have been used for quantitative uric acid detection using a simple, rapid colloidal SERS approach without the need for complex data analysis.

Evaluation of biomarkers for the prediction of pre-eclampsia in women with type 1 diabetes mellitus: A systematic review

BACKGROUND

Pre-eclampsia is a leading cause of maternal and perinatal morbidity and mortality. Women with type 1 diabetes are considered a high-risk group for developing pre-eclampsia. Much research has focused on biomarkers as a means of screening for pre-eclampsia in the general maternal population; however, there is a lack of evidence for women with type 1 diabetes.

OBJECTIVES

To undertake a systematic review to identify potential biomarkers for the prediction of pre-eclampsia in women with type 1 diabetes.

SEARCH STRATEGY

We searched Medline, EMBASE, Maternity and Infant Care, Scopus, Web of Science and CINAHL SELECTION CRITERIA: Studies were included if they measured biomarkers in blood or urine of women who developed pre-eclampsia and had pre-gestational type 1 diabetes mellitus Data collection and analysis A narrative synthesis was adopted as a meta-analysis could not be performed, due to high study heterogeneity.

MAIN RESULTS

A total of 72 records were screened, with 21 eligible studies being included in the review. A wide range of biomarkers was investigated and study size varied from 34 to 1258 participants. No single biomarker appeared to be effective in predicting pre-eclampsia; however, glycaemic control was associated with an increased risk while a combination of angiogenic and anti-angiogenic factors seemed to be potentially useful.

CONCLUSIONS

Limited evidence suggests that combinations of biomarkers may be more effective in predicting pre-eclampsia than single biomarkers. Further research is needed to verify the predictive potential of biomarkers that have been measured in the general maternal population, as many studies exclude women with diabetes preceding pregnancy.

Maternal serum glycosylated fibronectin as a point-of-care biomarker for assessment of preeclampsia

OBJECTIVE

We assessed the association of glycosylated fibronectin (GlyFn) with preeclampsia and its performance in a point-of-care (POC) test.

STUDY DESIGN

GlyFn, placental growth factor (PlGF), and soluble vascular endothelial growth factor receptor 1 (sFlt1) levels were determined in serum samples from 107 pregnant women. In all, 45 were normotensive and 62 were diagnosed with preeclampsia. The ability of GlyFn to assess preeclampsia status and relationships between GlyFn and maternal characteristics and pregnancy outcomes were analyzed.

RESULTS

GlyFn serum levels in the first trimester were significantly higher in women with preeclampsia (P < .01) and remained higher throughout pregnancy (P < .01). GlyFn, sFlt1, PlGF, and the sFlt1/PlGF ratio were significantly associated (P < .01) with preeclampsia status, and the classification performance of these analytes represented by area under the receiver operating characteristic curve was 0.99, 0.96, 0.94, and 0.98, respectively, with 95% confidence intervals of 0.98-1.00, 0.89-1.00, 0.86-1.00, and 0.94-1.00, respectively. Increased GlyFn levels were significantly associated with gestational age at delivery (P < .01), blood pressure (P = .04), and small-for-gestational-age neonates. Repeated-measures analysis of the difference in weekly GlyFn change in the third trimester demonstrated that mild preeclampsia was associated with a weekly change of 81.7 μg/mL (SE 94.1) vs 195.2 μg/mL (SE 88.2) for severe preeclampsia. The GlyFn POC demonstrated similar performance to a plate assay with an area under the receiver operating characteristic curve of 0.93 and 95% confidence interval of 0.85-1.00.

CONCLUSION

GlyFn is a robust biomarker for monitoring of preeclampsia in both a standard and POC format, which supports its utility in diverse settings.

Levels of brain derived neurotrophic factors across gestation in women with preeclampsia

Preeclampsia (PE) is a major pregnancy complication of placental origin which leads to adverse pregnancy outcome. Brain derived neurotrophic factor (BDNF) is suggested to promote trophoblast growth and regulate placental and fetal development. This study for the first time examines the levels of maternal plasma BDNF at various time points during gestation, cord plasma and placental BDNF levels and their association with birth outcome in women with PE. Normotensive control (NC) women (n=89) and women with PE (n=61) were followed at three different time points [16-20 weeks (T1), 26-30 weeks (T2) and at delivery (T3)]. Maternal blood at all time points and cord blood was collected. Results indicate that maternal BDNF levels at T1 (p=0.050) and T3 (p=0.025) were lower in women with PE than in NC women. Cord BDNF levels at delivery in women with PE were lower (p=0.032) than those in NC women. Placental BDNF gene expression was also lower (p=0.0082) in women with PE than in NC women. Our data suggests that BDNF plays an important role in the development of the materno-fetal-placental unit during pregnancy. Alteration in the levels of BDNF during pregnancy may be associated with an abnormal development of the placenta resulting in PE.

Inflammatory and procoagulant cytokine levels during pregnancy as predictors of adverse obstetrical complications

INTRODUCTION

Disturbances in cytokine networks are believed to be associated with increased risk of adverse pregnancy complications.

METHODS

Plasma samples collected from pregnant women with preterm deliveries, high-risk pregnancy complications including postpartum hemorrhage, hypertensive disorders, and multiple gestations, and normal pregnancies were analyzed at different periods throughout gestation and postpartum. Interleukin (IL) 1β , IL-6, IL-8, IL-10, tumor necrosis factor α, and antiprotein Z antibody levels were measured by enzyme-linked immunosorbent assay.

RESULTS

The IL-6 levels in preterm delivery patients were elevated during pregnancy with statistically significant differences observed at 21 to 32 weeks (P < .01) and 33+ weeks (P < .001). The IL-10 levels were increased in normal pregnancy at all time points compared to the other patient groups (P < .05). The TNF-α levels were elevated in the high-risk pregnancy group versus normal controls (P < .001 at <21 weeks and P < .05 at 21-32 weeks).

CONCLUSION

Analysis of the maternal plasma for elevated IL-6 and reduced IL-10 levels may be of value in the early prediction of pregnancy complications.

Evaluation of serum β-hCG and PAPP-A levels in pregnant women at risk of developing preeclampsia

BACKGROUND AND AIM

Preeclampsia remains a major problem of modern obstetrics with insufficiently elucidated etiology; early detection would diminish maternal and fetal mortality and morbidity. The aim of this study was to determine the serum values of β-hCG in the first and second trimesters of pregnancy and PAPP-A values in the first trimester of pregnancy in pregnant women with risk factors for preeclampsia, in order to evaluate their relevance in the prediction of this disorder.

MATERIAL AND METHODS

We performed a prospective longitudinal study on 120 pregnant women divided into two groups according to the evolution of pregnancy: group I - 26 pregnant women who developed preeclampsia and group II - 94 pregnant women who did not develop preeclampsia and had a physiological evolution of pregnancy.

RESULTS

Our results indicate the association between high β-hCG levels in the first and second trimesters of pregnancy and the development of PE, β-hCG having the highest predictive power in the second trimester. We also obtained a positive association between low serum levels in PAPP-A in the first trimester and onset of PE. The predictive power of conjugated β-hCG and PAPP-A values in the first trimester of pregnancy was better that any other marker analyzed separately.

CONCLUSIONS

Increased β-hCG levels in the first and second trimesters of pregnancy and low PAPP-A levels in the second trimester of pregnancy are associated with a higher risk for PE, the study providing only a modest efficiency of the prediction capacity.