Placental Protein 13 as an Early Marker for Preeclampsia: A Prospective Longitudinal Study

Prediction of adverse pregnancy outcomes by combinations of first and second trimester biochemistry markers used in the routine prenatal screening of Down syndrome

“…In addition to serum markers used in routine prenatal screening, other serum markers have also been linked to adverse pregnancy outcomes, including first trimester ADAM12, placental growth factor (PLGF), placental protein 13 (PP13), and second trimester Activin A and soluble fms-like tyrosine kinase 1 (sFLT1). These newer biomarkers appear to be better at predicting pregnancies that will develop preeclampsia and SGA (Erez et al, 2008;Gonen et al, 2008;Pihl et al, 2008). Biophysical tests such as uterine artery Doppler in combination with serum markers and clinical factors have also demonstrated promising results on unselected women as early as the first trimester (Poon et al, 2009) and when used on a subgroup of women with abnormal levels of serum markers identified through prenatal screening (Toal et al, 2008).…”

First trimester maternal serum placental protein 13 levels in singleton vs. twin pregnancies with and without severe pre-eclampsia

“…It was then centrifuged for 15 min at 3000 g, and the serum was collected and stored at -20°C for up to 4 days until it was transferred to a central laboratory in cool boxes kept at this temperature. Samples were tested for PP13 within 2-12 days of blood drawing (see below), levels were converted into multiple of the medians (MoMs) as previously described by Gonen et al [14], and the patients were given the test report form, which included the PP13 level and specified that the result was high risk if PP13 < 0.4 MoM.…”

“…The levels of PP13 were prospectively determined using the enzyme-linked immune sorbent assay (ELISA) according to the sandwich method as previously described [14,17,18,26]. The laboratory technicians were blinded as to whether the samples were obtained from singletons or twins.…”

“…The study results may be affected by socio-economic bias because of enrollment in a private health setting, where in one of our cohorts the PP13 test was paid by the patients themselves. Also, there was a higher PE frequency compared to the local incidence [14] as a result of a disproportionate enrollment of patients with high prior risk, who were aware of their conditions and of the need to modify pregnancy management. However, Khalil et al [18] have shown that the distribution of PP13 levels in high-risk populations is not as different from low-risk populations that were described by Gonen et al [14].…”

“…The protein, also known as galectin 13, is exclusively produced in the syncytiotrophoblast layer of the placenta, from where it reaches the maternal blood circulation from as early as the 6 th week of gestation [3,17]. In singleton pregnancies, lower first trimester levels of PP13 can be used, together with other markers, for predicting an individual woman's risk of developing preeclampsia (PE) [14,17,18,26]. This disorder, affecting 2%-7% of all pregnancies, is associated with feto-maternal morbidity, hypertension, and affecting the maternal kidneys and occasionally other vital organs [1,25,32], as well as a high frequency of fetal growth restriction (FGR), and other fetal morbidities [29,32].…”