Abstract-A state of insulin resistance has been demonstrated in active preeclampsia, and women with clinical evidence of insulin resistance are at higher risk to develop this syndrome during pregnancy. Recently, inositol phosphoglycan P-type, a putative second messenger of insulin action, has been implicated in the pathophysiology of preeclampsia and is increased in the placenta, amniotic fluid, and maternal urine of preeclamptic women compared with normal pregnant women. We report here a case-control study to assess the potential of urinary levels of inositol phosphoglycan P-type as a screening test for preeclampsia. Twenty-seven preeclamptic women and 47 healthy pregnant women were recruited. A polyclonal antibody-based ELISA was developed to detect levels of inositol phosphoglycan P-type in urine. Its content in urinary specimens was found to be 30-fold higher in preeclamptic subjects than control subjects (329.1Ϯ21.8 versus 9.2Ϯ1.5; PϽ0.001), with a higher level in all of the preeclamptic cases. For 6 women who developed preeclampsia, Ͼ1 gestational date sample of urine was available, and retrospective analysis showed a significant time-related increase of the urinary level of inositol phosphoglycan P-type Յ7 weeks before clinical diagnosis of preeclampsia. Urinary level of inositol phosphoglycan P-type increased after diagnosis indicating a possible pathophysiological threshold level and steeply decreased after delivery. Key Words: preeclampsia Ⅲ screening test Ⅲ inositol phosphoglycan Ⅲ biological marker Ⅲ insulin resistance P reeclampsia (PE) represents the most severe form of hypertensive disorder of human pregnancy being associated with a substantial maternal and perinatal morbidity and mortality. 1 It affects Ϸ5% of all pregnancies, although its causes remain unclear. A state of insulin resistance has been demonstrated in active PE, 2,3 and women with clinical evidence of insulin resistance are at higher risk of developing this syndrome during pregnancy. 4 Recently, a family of putative insulin mediators, inositol phosphoglycans (IPGs), have been implicated in the pathophysiology of PE. A high concentration of bioactive IPG P-type (P-IPG) was found in human preeclamptic placenta, 5 urine, and amniotic fluid. 6 Further studies have provided evidence of insulin resistance in human placentas from preeclamptic pregnancies and demonstrated an association between P-IPG and the insulin signaling cascade. 7 IPGs have been demonstrated to exert insulin-mimetic activity in both glucose and lipid metabolism mainly through the activation of pyruvate dehydrogenase phosphatase, glycogen synthase phosphatase, and glycerol-3-phosphate acyltransferase. 8,9 The elevated concentration of glycogen in terminal villi from preeclamptic placentas, because of an increased activity of glycogen synthase, 10 may be a consequence of the abnormal content of P-IPG in the placentas of preeclamptic patients.In this report, we focus our attention on the urinary excretion of IPGs using a novel assay specifically developed to analyze uri...