First-trimester maternal serum PP13 in the risk assessment for preeclampsia

Romero, Roberto; Kusanovic, Juan Pedro; Than, Nándor Gábor; Erez, Offer; Gotsch, Francesca; Espinoza, Jimmy; Edwin, Samuel S.; Chefetz, Ilana; Gomez, Ricardo; Nien, Jyh Kae; Sammar, Marei; Pineles, Beth L.; Hassan, Sonia S.; Meiri, Hamutal; Tal, Yossi; Kuhnreich, Ido; Papp, Zoltán; Cuckle, Howard

doi:10.1016/j.ajog.2008.01.013

Cited by 143 publications

(116 citation statements)

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“…This study was limited to only 10 cases of early-onset PE. However, the results are in agreement with data from Romero et al (38 ), who observed that PP-13 appears to be an interesting marker for risk assessment of preterm PE but a weak marker for severe PE at term, and ineffective for identifying mild PE at term. Also, data from Spencer et al (39 ) suggested that first trimester serum PP-13 as a single marker in a low-risk population showed poor predictive performance.…”

Section: Discussionsupporting

confidence: 92%

Combining Biochemical and Ultrasonographic Markers in Predicting Preeclampsia: A Systematic Review

et al. 2010

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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 preeclampsia. Combinations of markers generally led to an increase in sensitivity and/or specificity compared with single markers. In low-risk populations, combinations including placental protein 13 (PP13), pregnancy-associated plasma protein A (PAPP-A), a disintegrin and metalloprotease-12 (ADAM12), activin A, or inhibin A measured in first or early second trimester and uterine artery Doppler in second trimester appear promising (sensitivity 60%-80%, specificity Ͼ80%). In high-risk populations, the combination of PP13 and pulsatility index in first tri-

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Section: Discussionsupporting

confidence: 92%

Combining Biochemical and Ultrasonographic Markers in Predicting Preeclampsia: A Systematic Review

et al. 2010

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“…Than et al [66] found reduced PP13 mRNA levels in placentas obtained from patients with preeclampsia and HELLP syndrome in the first trimester compared to controls. Blood levels of PP13 mRNA were also significantly lower in preeclampsia compared to controls [67] . Pregnancy associated plasma protein-A Pregnancy associated plasma protein-A (PAPP-A) is mainly produced by the placental trophoblasts.…”

Section: Placental Protein 13mentioning

confidence: 81%

Preeclampsia from a renal point of view: Insides into disease models, biomarkers and therapy

Müller-Deile

Schiffer

2014

WJN

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Proteinuria is a frequently detected symptom, found in 20% of pregnancies. A common reason for proteinuria in pregnancy is preeclampsia. To diagnose preeclampsia clinically and to get new insights into the pathophysiology of the disease it is at first essential to be familiar with conditions in normal pregnancy. Animal models and biomarkers can help to learn more about disease conditions and to find new treatment strategies. In this article we review the changes in kidney function during normal pregnancy and the differential diagnosis of proteinuria in pregnancy. We summarize different pathophysiological theories of preeclampsia with a special focus on the renal facets of the disease. We describe the current animal models and give a broad overview of different biomarkers that were reported to predict preeclampsia or have a prognostic value in preeclampsia cases. We end with a summary of treatment options for preeclampsia related symptoms including the use of plasmapheresis as a rescue therapy for so far refractory preeclampsia. Most of these novel biomarkers for preeclampsia are not yet implemented in clinical use. Therefore, we recommend using proteinuria (measured by UPC ratio) as a screening parameter for preeclampsia. Delivery is the only curative treatment for preeclampsia. In early preeclampsia the primary therapy goal is to prolong pregnancy until a state were the child has an acceptable chance of survival after delivery.© 2014 Baishideng Publishing Group Inc. All rights reserved.Key words: Preeclampsia; Pregnancy; Proteinuria; Biomarkers; Treatment Core tip: This review summarises different pathophysiological theories of preeclampsia with a special focus on the renal facets of the disease. In this context current animal models are presented. The reader gets a broad overview about different biomarkers for preeclampsia. Furthermore, the article discusses treatment options for preeclampsia related symptoms including the use of plasmapheresis as a rescue therapy for so far refractory preeclampsia.Müller-Deile J, Schiffer M. Preeclampsia from a renal point of view: Insides into disease models, biomarkers and therapy. World

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“…Recent studies are focusing in predicting preeclampsia with use of uterine artery Doppler velocimetry and other biochemical markers in the first trimester. [100,[147][148][149][150][151][152][153][154][155][156] …”

Section: Strengths and Limitations Of The Studymentioning

confidence: 99%

A prospective cohort study of the value of maternal plasma concentrations of angiogenic and anti-angiogenic factors in early pregnancy and midtrimester in the identification of patients destined to develop preeclampsia

Kusanovic¹,

Romero²,

Chaiworapongsa³

et al. 2009

DJMF

Self Cite

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OBJECTIVE-Changes in the maternal plasma concentrations of angiogenic (such as PlGF and VEGF) and anti-angiogenic factors (such as sEng and sVEGFR-1) precede the clinical presentation of preeclampsia. This study was conducted to examine the role of maternal plasma PlGF, sEng and sVEGFR-1 concentrations in early pregnancy and midtrimester in the identification of patients destined to develop preeclampsia.METHODS-This longitudinal cohort study included 1,622 consecutive singleton pregnant women. Plasma samples were obtained in early pregnancy (6-15 weeks) and midtrimester (20-25 weeks). Maternal plasma PlGF, sEng and sVEGFR-1 concentrations were determined using sensitive and specific immunoassays. The primary outcome was the development of preeclampsia. Secondary outcomes included term, preterm and early-onset preeclampsia. Receiving operating characteristic (ROC) curves, sensitivity, specificity, positive and negative likelihood ratios, and multivariable logistic regression were used for statistical analyses. A p-value of <0.05 was considered significant. RESULTS-1)The prevalence of preeclampsia, term, preterm (<37 weeks) and early-onset preeclampsia (<34 weeks) was 3.8% (62/1,622), 2.5% (40/1,622), 1.4% (22/1,622) and 0.6% (9/1,622), respectively; 2) Higher likelihood ratios were provided by ratios of midtrimester plasma concentrations of PlGF, sEng, and sVEGFR-1 than single analytes; 3) Individual angiogenic and anti-angiogenic factors did not perform well in the identification of preeclampsia as a whole; in particular, they perform poorly in the prediction of term preeclampsia; 4) In contrast, a NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript combination of these analytes such as the PlGF/sEng ratio, its delta and slope had the best predictive performance with a sensitivity of 100%, a specificity of 98%-99%, and likelihood ratios for a positive test of 57.6, 55.6 and 89.6, respectively, for predicting early-onset preeclampsia. CONCLUSIONS-1)The PlGF/sEng ratio and its delta and slope had an excellent predictive performance for the prediction of early-onset preeclampsia, with very high likelihood ratios for a positive test result and very low likelihood ratios for a negative test result; and 2) Although the positive likelihood ratios are high and the positive predictive values low, the number of patients needed to be closely followed is 4:1 for the PlGF/sEng ratio and 3:1 for the slope of PlF/sEng.

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First-trimester maternal serum PP13 in the risk assessment for preeclampsia

Abstract: Maternal serum first-trimester PP13 appears to be a reasonable marker for risk assessment for preterm preeclampsia but a weak marker for severe preeclampsia at term, and ineffective for identifying mild preeclampsia at term.

Cited by 143 publications

References 96 publications

Combining Biochemical and Ultrasonographic Markers in Predicting Preeclampsia: A Systematic Review

Combining Biochemical and Ultrasonographic Markers in Predicting Preeclampsia: A Systematic Review

Preeclampsia from a renal point of view: Insides into disease models, biomarkers and therapy

A prospective cohort study of the value of maternal plasma concentrations of angiogenic and anti-angiogenic factors in early pregnancy and midtrimester in the identification of patients destined to develop preeclampsia

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