The addition of activin A and inhibin A measurement to uterine artery Doppler velocimetry to improve the early prediction of pre‐eclampsia

Objective To evaluate whether the measurement of maternal serum activin A and inhibin A adds any clinically relevant information for the prediction of pre‐eclampsia in women with altered uterine artery Doppler velocimetry at 24 weeks of gestation. Methods This was a prospective, controlled, hospital‐based study involving 58 asymptomatic pregnant women at 24 weeks' gestation in whom a diastolic notch of the uterine artery waveform was noted at routine Doppler examination. Doppler assessment of the uterine artery waveform and measurement of maternal activin A and inhibin A serum levels by specific two‐site enzyme immunoassays were performed. The cut‐off points for defining ‘high’ serum activin A and inhibin A levels for prediction of pre‐eclampsia were chosen by receiver–operating characteristics (ROC) curve analysis. The probability of developing pre‐eclampsia was calculated for several combinations of results of hormone testing. Results Activin A and inhibin A levels were higher in patients who developed pre‐eclampsia (n = 18; mean ± standarderror : 2.69 ± 0.35 ng/mL and 131.2 ± 22.7 pg/mL, respectively) than in those who did not present with pre‐eclampsia at follow‐up (n = 40; activin A: 1.79 ± 0.18 ng/mL and inhibin A: 91.9 ± 6.2 pg/mL; P < 0.05). Activin A at the cut‐off value of 1.7 multiples of the median (MoM) achieved a sensitivity of 61% and a specificity of 89%, whereas inhibin A at the cut‐off value of 1.8 MoM combined a sensitivity of 39% with a specificity of 92% for prediction of pre‐eclampsia. The probability of pre‐eclampsia was 31% in the whole study population, 86% if both activin A and inhibin A were elevated and 17% if both hormone markers were unaltered. Conclusion The measurement of serum activin A and inhibin A levels may add significant prognostic information for predicting pre‐eclampsia in pregnant women showing specific Doppler alterations in the late second trimester. Copyright © 2003 ISUOG. Published by John Wiley & Sons, Ltd.