Second-trimester maternal serum placental growth factor and vascular endothelial growth factor for predicting severe, early-onset preeclampsia.
ABSTRACT To determine whether alterations in second-trimester maternal serum cytokine concentrations can identify women at risk for developing severe, early-onset preeclampsia.
Patients with severe preeclampsia requiring delivery prior to 34 weeks (n = 20) were each matched by gestational age, gravidity, parity, and sample freezing time with three healthy controls who delivered at term (n = 60). By using second-trimester maternal sera originally collected for fetal aneuploidy screening, the concentrations of placental growth factor, vascular endothelial growth factor, granulocyte colony-stimulating factor, endothelin-1, and human chorionic gonadotropin were compared between patients and controls. Logistic regression analysis was used to estimate odds ratios for high versus low (median split) cytokine concentrations with respect to the development of severe, early-onset preeclampsia. Receiver operating characteristic (ROC) curves based on a second logistic regression, using actual cytokine values, were plotted to illustrate reciprocal impact on sensitivity and specificity.
Placental growth factor and vascular endothelial growth factor levels were significantly lower in patients than in controls. No significant differences were observed for the other cytokines. The odds ratios (with 95% confidence intervals) were 15.54 (3.29, 73.40) for vascular endothelial growth factor and 4.20 (1.35, 13.06) for placental growth factor. Receiver operating characteristic analysis of placental growth factor and vascular endothelial growth factor confirmed that both were useful in discriminating between patients and controls. Models combining both vascular endothelial growth factor and placental growth factor provided the best performance for identifying patients at risk for developing severe, early-onset preeclampsia, according to both odds ratios and ROC analyses.
Combined analysis of placental growth factor and vascular endothelial growth factor is potentially useful as a tool for early identification of patients at risk for developing severe, early-onset preeclampsia.
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ABSTRACT: To evaluate whether measurement of maternal serum PP13 at 22 to 24 weeks of gestation, alone or in combination with second-trimester biochemical markers or uterine artery pulsatility measured by Doppler velocimetry, is useful in predicting those women at risk of developing pre-eclampsia. A nested case-control study of pre-eclampsia cases with controls matched for gestational age and storage time for the maternal serum. PP13 was tested by an ELISA, with the samples blinded to pregnancy outcome. All patients also underwent uterine artery Doppler flow velocimetry at 22-24 weeks to measure the mean pulsatility index (PI). Results for Inhibin, Activin, PAPP-A and Free beta-hCG were available from previous studies. There were 73 controls and five cases with early pre-eclampsia in which delivery was induced prior to 35 weeks. In addition, there were a further seven cases with pre-eclampsia in which delivery was not induced before term. Median PP13 levels for controls and all cases were 295.9 and 212.6 pg/ml, and 171.2 pg/ml amongst the early pre-eclampsia cases, with the MoMs 1.00, 0.94 and 0.63, respectively (p < 0.001). Receiver operator characteristic (ROC) curve analysis for either all cases or early cases versus controls yielded areas under the curve of 0.588 (95% CI: 0.42-0.76; p = 0.1526) and 0.693 (0.47-0.92; p = 0.0441) for PP13. At a specificity set to 0.80, the sensitivity for PP13 in the early cases was 0.40 and that in all cases was 0.25. Combining PP13 bivariately with any of the markers (PI, PAPP-A, Activin, Inhibin or Free beta-hCG) tested in the 22-24 week period did not improve the detection of early, late or all cases of pre-eclampsia compared with either marker alone. Late second-trimester PP13 alone is unlikely to be useful in predicting pre-eclampsia and early pre-eclampsia, and its prediction does not increase when coupled with second-trimester Doppler PI or other potential biochemical markers. Measuring between-trimester temporal changes may be worthy of further investigation.Prenatal Diagnosis 03/2007; 27(3):258-63. DOI:10.1002/pd.1664 · 2.51 Impact Factor
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ABSTRACT: Objectives: To investigate into an association between circulating levels of vascular factors (VF: ACE, eNOS, PlGF and VEGF) and impaired fetal growth measured as a small for gestational age newborn (SGA) in women with gestational hypertension/preeclampsia. Methods: A prospective observational trial in 46 patients in singleton pregnancies. Concentrations of VF were compared between participants who delivered SGA versus non-SGA newborns. Results: only low levels of ACE were associated with significantly increased risk for SGA (for a cut-off value, LR: 1.4–3.6). Conclusions: Circulating levels of VF are not sufficient predictors of SGA in pregnancies complicated by gestational hypertension/preeclampsia.Hypertension in Pregnancy 09/2014; 34(1). DOI:10.3109/10641955.2014.951490 · 1.19 Impact Factor
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ABSTRACT: Preeclampsia, “the disease of theory”, is a major cause of maternal mortality and morbidities, perinatal deaths, preterm birth, and intrauterine growth restriction. Several pathophysiological mechanisms have been proposed in the development of preeclampsia, including endothelial dysfunction, an inflammatory pathway, oxidative stress, activation of thrombosis, the renin-angiotensin system and angiogenic factors contribute in pathogenesis of preeclampsia. However, the individual theory cannot explain preeclampsia in holistically setting. The discovery of MicroRNA in 1993 has had a huge influence in pathogenesis theory; diagnosis and treatment approach to some diseases. Albeit only 1% of the genomic transcripts, it has been estimated that miRNAs regulate ~30% of human genes. This book discusses the roles of MicroRNA in several pathophysiological mechanisms have been proposed in the development of preeclampsia in advance setting. This book, clearly, shows the role of MicroRNA as a new aspect in pathobiology of preeclampsia. This book helps people to understanding more about preeclampsia from advance stand point.1st Edition 01/2012; LAP Lambert Academic Publishing., ISBN: 978-3-659-28513-4