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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?
Author(s) -
Myatt L,
Clifton RG,
Roberts JM,
Spong CY,
Wapner RJ,
Thorp JM,
Mercer BM,
Peaceman AM,
Ramin SM,
Carpenter MW,
Sciscione A,
Tolosa JE,
Saade G,
Sorokin Y,
Anderson GD
Publication year - 2013
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.12128
Subject(s) - medicine , eclampsia , placental growth factor , obstetrics , preeclampsia , pregnancy , gestation , gynecology , vascular endothelial growth factor , vegf receptors , genetics , biology
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 F lt‐1 ( sF lt‐1), soluble endoglin ( sE ng) 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 , sF lt‐1 and sE ng 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 , sF lt‐1 and sE ng. Results Rates of change of PlGF , sE ng and sF lt‐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 sE ng, PlGF and sF lt‐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.