Document Type
Journal Article
Publication Date
1-18-2013
Journal
BJOG: An International Journal of Obstetrics and Gynaecology
Volume
Volume 120, Issue 10
Inclusive Pages
1183-1191
Keywords
Antigens, CD--blood; Pre-Eclampsia--blood; Pregnancy Proteins--blood; Pregnancy Trimester, First--blood; Pregnancy Trimester, Second--blood; Receptors, Cell Surface--blood; Vascular Endothelial Growth Factor Receptor-1--blood
Abstract
OBJECTIVE:
To determine if change in maternal angiogenic biomarkers between the first and second trimesters predicts pre-eclampsia in low-risk nulliparous women.
DESIGN:
A nested case-control study of change in maternal plasma soluble Flt-1 (sFlt-1), soluble endoglin (sEng) and placenta growth factor (PlGF). We studied 158 pregnancies complicated by pre-eclampsia and 468 normotensive nonproteinuric controls.
SETTING:
A multicentre study in 16 academic medical centres in the USA.
POPULATION:
Low-risk nulliparous women.
METHODS:
Luminex assays for PlGF, sFlt-1 and sEng performed on maternal EDTA plasma collected at 9-12, 15-18 and 23-26 weeks of gestation. Rate of change of analyte between first and either early or late second trimester was calculated with and without adjustment for baseline clinical characteristics.
MAIN OUTCOME MEASURES:
Change in PlGF, sFlt-1 and sEng.
RESULTS:
Rates of change of PlGF, sEng and sFlt-1 between first and either early or late second trimesters were significantly different in women who developed pre-eclampsia, severe pre-eclampsia or early-onset pre-eclampsia compared with women who remained normotensive. Inclusion of clinical characteristics (race, body mass index and blood pressure at entry) increased sensitivity for detecting severe and particularly early-onset pre-eclampsia but not pre-eclampsia overall. Receiver operating characteristics curves for change from first to early second trimester in sEng, PlGF and sFlt-1 with clinical characteristics had areas under the curve of 0.88, 0.84 and 0.86, respectively, and for early-onset pre-eclampsia with sensitivities of 88% (95% CI 64-99), 77% (95% CI 50-93) and 77% (95% CI 50-93) for 80% specificity, respectively. Similar results were seen in the change from first to late second trimester.
CONCLUSION:
Change in angiogenic biomarkers between first and early second trimester combined with clinical characteristics has strong utility for predicting early-onset pre-eclampsia.
Creative Commons License
This work is free of known copyright restrictions.
APA Citation
Myatt, L., Clifton, R.G., Roberts, J.M., Spong, C.Y., Wapner, R.J. et al. (2013). Can changes in angiogenic biomarkers between the first and second trimesters of pregnancy predict development of pre-eclampsia in a low-risk nulliparous patient population? BJOG: An International Journal of Obstetrics and Gynaecology, 120(10), 1183-1191.
Peer Reviewed
1
Open Access
1
Comments
This article is a U.S. Government work and is in the public domain in the USA.
Originally published in BJOG: An International Journal of Obstetrics and Gynaecology.