Serum Markers for the Prediction of Preeclampsia (original) (raw)
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Prediction of Preeclampsia: Role of Antiangiogenic and Proangiogenic Biomarkers
Journal of South Asian Federation of Obstetrics and Gynaecology, 2017
ABSTRACTThe pathogenesis of preeclampsia (PE) is unknown, but recent studies have revealed that placenta is the place of origin of this disorder, and widespread maternal endothelial dysfunction is the charactertstic feature of the disease. Some biochemical molecules that are involved in the pathogenesis of the disease have recently been identified, which may help in early identification of patients at risk and help in providing proper prenatal care. Several promising biomarkers have been proposed, alone or in combination. Maternal serum concentrations of these biomarkers either increase or decrease in PE during gestation. This review focuses on the various biomarkers available and their utility in prediction and diagnosis of PE.How to cite this articleGarg R, Roy P, Agrawal P, Shanthakumari S. Prediction of Preeclampsia: Role of Antiangiogenic and Proangiogenic Biomarkers. J South Asian Feder Obst Gynae 2017;9(1): 47-52.
Combining Biochemical and Ultrasonographic Markers in Predicting Preeclampsia: A Systematic Review
Clinical Chemistry, 2009
Background: Early identification of pregnant women at risk for preeclampsia is a priority to implement preventive measures. Some biochemical and ultrasonographic parameters have shown promising predictive performance, but so far there is no clinically validated screening procedure. Content: Using a series of keywords, we reviewed electronic databases (Medline, Embase, all records to May 2009) reporting the performance of biological and ultrasonographic markers to predict preeclampsia, both single markers and combinations of markers. We analyzed the data according to gestational age and risk levels of the studied populations. We evaluated the methodological quality of included publications using QUADAS (quality assessment of diagnostic accuracy studies). We identified 37 relevant studies that assessed 71 different combinations of biochemical and ultrasonographic markers. Most studies were performed during the second trimester on small-scale high-risk populations with few cases of pre...
Review: Biochemical markers to predict preeclampsia
Placenta, 2012
Worldwide the prevalence of preeclampsia (PE) ranges from 3 to 8% of pregnancies. 8.5 million cases are reported yearly, but this is probably an underestimate due to the lack of proper diagnosis. PE is the most common cause of fetal and maternal death and yet no specific treatment is available. Reliable biochemical markers for prediction and diagnosis of PE would have a great impact on maternal health and several have been suggested. This review describes PE biochemical markers in general and first trimester PE biochemical markers specifically. The main categories described are angiogenic/antiangiogenic factors, placental proteins, free fetal hemoglobin (HbF), kidney markers, ultrasound and maternal risk factors. The specific biochemical markers discussed are: PAPP-A, s-Flt-1/PlGF, s-Endoglin, PP13, cystatin-C, HbF, and a 1 -microglobulin (A1M). PAPP-A and HbF both show potential as predictive biochemical markers in the first trimester with 70% sensitivity at 95% specificity. However, PAPP-A is not PE-specific and needs to be combined with Doppler ultrasound to obtain the same sensitivity as HbF/ A1M. Soluble Flt -1 and PlGF are promising biochemical markers that together show high sensitivity from the mid-second trimester. PlGF is somewhat useful from the end of the first trimester. Screening pregnant women with biochemical markers for PE can reduce unnecessary suffering and health care costs by early detection of mothers at increased risk for PE, thus avoiding unnecessary hospitalization of pregnant women with suspect or mild PE and enabling monitoring of the progression of the disease thereby optimizing time for delivery and hopefully reducing the number of premature births.
Biochemical Markers In The Prediction Of Pre-Eclampsia, Are We There Yet?
The Internet Journal of Gynecology and Obstetrics
Over the last two decades various biochemical tests that have been proposed for the prediction of preeclampsia are described and evaluated. These tests are apparently better predictors when preeclampsia supervenes shortly. Thus, explaining why screening in the first trimester is unlikely to produce results as in the second trimester. The current use of multiple markers in the screening reflects that different aspects of the disease processes being evaluated hence are increasing the specificity and sensitivity of the screening tests which works on different contributing factors in its etiology. Ultimately to be practical, the screening tests needs to be simple, fast and cost effective. Urinary soluble endoglin, different profiles of Angiogenic factors ,cellfree DNA of the fetal erythrocytes, proteomics are selectively promising as future biochemical markers Some of these tests are currently available for clinical use, whereas others exist only in the laboratory in view of its cost.
Candidate biochemical markers for screening of pre-eclampsia in early pregnancy
Clinical Chemistry and Laboratory Medicine, 2012
Pre-eclampsia (PE) and other hypertensive disorders of pregnancy (HDP) are a leading cause of adverse outcomes. Their pathophysiology remains elusive, hampering the development of effi cient prevention. The onset of HDP and PE and the severity of their clinical manifestations are heterogeneous. The advent of preventive measures, such as low-dose aspirin that targets high-risk women, emphasizes the need of better prediction. Until recently, only environmental information and maternal risk factors were considered, with equivocal predictive value. No validated screening procedures were available to identify at-risk women despite the emergence of Doppler ultrasonography parameters for the uterine artery (e.g., pulsatility index and bilateral notching) and pathophysiological biochemical markers (e.g., angiogenesis, infl ammation, and endothelial dysfunction). Owing to its heterogeneity and lack of specifi c, sensitive markers among those studied so far (> 200), PE is unlikely to be detected early by a single predictive parameter. Systematic reviews have concluded that no single test fulfi lling World Health Organization criteria for biomarker selection can diagnose/predict a disease. However, by combining antenatal risk factors, clinical parameters, as well as biophysical and biochemical markers into multivariate algorithms, the risk of PE can be estimated with performance levels that could reach clinical utility. Performance characteristics of selected algorithms will be presented and discussed with respect to transferability to different geographic and healthcare environments.
Use of first or second trimester serum markers, or both, to predict preeclampsia
Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health, 2014
Objectives: Preeclampsia is a serious complication of pregnancy, threatening fetal and maternal health. The aim of our study is to examine the association between preeclampsia and biochemical markers, in matched first and second trimester maternal serum samples. Study design: This is a nested case/control study derived from the cohort of pregnancies delivering at Women & Infants Hospital. Cases were identified at a clinic or by hospital codes, and individually confirmed by record review. Stored samples were available from 'integrated' Down syndrome screening. Results were expressed as multiples of the median (MoM). Main outcome measures: Preeclampsia was classified as early/severe, late/severe, or mild based on professional guidelines. An additional adverse outcome group had only gestational hypertension. Results: Ninety-eight cases were each matched with five control pregnancies. Population distribution parameters and within and between trimester correlations were derived for cases and controls for six markers, as well as in case subgroups. The strongest associations were for early/severe preeclampsia with second trimester PAPP-A (rank sum test 2.30, p < 0.01); PlGF (2.60, p < 0.05) inhibin A (4.45, p < 0.05) and endoglin (4.25, p < 0.05). No strong associations were found for sVEGF-R and FLRG. Second trimester associations were stronger than those in the first (e.g., PAPP-A 2.45, p < 0.01). No between-trimester associations were found that would provide important improvements in prediction. Conclusions: This matched analysis of the serum markers in early pregnancy allows for direct comparison of first and second trimester associations with preeclampsia. PAPP-A and PlGF are equally and highly predictive of early/severe preeclampsia.
Potential markers of preeclampsia--a review
Reproductive biology and endocrinology : RB&E, 2009
Preeclampsia is a leading cause of maternal and fetal/neonatal mortality and morbidity worldwide. The early identification of patients with an increased risk for preeclampsia is therefore one of the most important goals in obstetrics. The availability of highly sensitive and specific physiologic and biochemical markers would allow not only the detection of patients at risk but also permit a close surveillance, an exact diagnosis, timely intervention (e.g. lung maturation), as well as simplified recruitment for future studies looking at therapeutic medications and additional prospective markers. Today, several markers may offer the potential to be used, most likely in a combinatory analysis, as predictors or diagnostic tools. We present here the current knowledge on the biology of preeclampsia and review several biochemical markers which may be used to monitor preeclampsia in a future, that, we hope, is not to distant from today.
Prenatal diagnosis, 2011
ObjectiveTo develop models for prediction of pre-eclampsia (PE) based on maternal factors and biophysical and biochemical markers at 11–13 weeks' gestation.To develop models for prediction of pre-eclampsia (PE) based on maternal factors and biophysical and biochemical markers at 11–13 weeks' gestation.MethodsScreening study of singleton pregnancies at 11–13 weeks including 752 (2.2%) that subsequently developed PE and 32 850 that were unaffected by PE. Models were developed for the prediction of early PE, requiring delivery before 34 weeks, intermediate PE with delivery at 34–37 weeks and late PE delivering after 37 weeks. The data used for the models were firstly, maternal characteristics and history, uterine artery pulsatility index, mean arterial pressure and serum pregnancy-associated plasma protein-A obtained from the screening study and secondly, maternal serum or plasma concentration of placental growth factor, placental protein-13, inhibin-A, activin-A, soluble endoglin, pentraxin-3 and P-selectin obtained from case-control studies.Screening study of singleton pregnancies at 11–13 weeks including 752 (2.2%) that subsequently developed PE and 32 850 that were unaffected by PE. Models were developed for the prediction of early PE, requiring delivery before 34 weeks, intermediate PE with delivery at 34–37 weeks and late PE delivering after 37 weeks. The data used for the models were firstly, maternal characteristics and history, uterine artery pulsatility index, mean arterial pressure and serum pregnancy-associated plasma protein-A obtained from the screening study and secondly, maternal serum or plasma concentration of placental growth factor, placental protein-13, inhibin-A, activin-A, soluble endoglin, pentraxin-3 and P-selectin obtained from case-control studies.ResultsIn screening for PE by maternal factors only at a fixed false positive rate of 5%, the estimated detection rates were 33.0% for early PE, 27.8% for intermediate PE and 24.5% for late PE. The respective detection rates in screening by a combination of maternal factors, biophysical and biochemical markers were 91.0, 79.4 and 60.9%.In screening for PE by maternal factors only at a fixed false positive rate of 5%, the estimated detection rates were 33.0% for early PE, 27.8% for intermediate PE and 24.5% for late PE. The respective detection rates in screening by a combination of maternal factors, biophysical and biochemical markers were 91.0, 79.4 and 60.9%.ConclusionsEffective prediction of PE can be achieved at 11–13 weeks' gestation. Copyright © 2011 John Wiley & Sons, Ltd.Effective prediction of PE can be achieved at 11–13 weeks' gestation. Copyright © 2011 John Wiley & Sons, Ltd.