Grigorios A Karampas1, Makarios I Eleftheriades2, Konstantinos C Panoulis3, Myrto D Rizou4, Alexander D Haliassos4, Dimitra K Metallinou5, George P Mastorakos6, Demetrios A Rizos7. 1. Second Department of Obstetrics & Gynecology, Medical School, University of Athens "Aretaieio" Hospital, Athens, Greece. Electronic address: karampasgrig@gmail.com. 2. Second Department of Obstetrics & Gynecology, Medical School, University of Athens "Aretaieio" Hospital, Athens, Greece; "EmbryoCare", Fetal Medicine Unit, Athens, Greece. 3. Second Department of Obstetrics & Gynecology, Medical School, University of Athens "Aretaieio" Hospital, Athens, Greece. 4. "Diamedica SA", Clinical Chemistry Laboratory, Athens, Greece. 5. Department of Midwifery, Faculty of Health and Caring Professions, Technological Educational Institute of Athens, Athens, Greece. 6. Endocrine Unit, Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, University of Athens, Athens, Greece. 7. Second Department of Obstetrics & Gynecology, Medical School, University of Athens "Aretaieio" Hospital, Athens, Greece; Hormone Laboratory, "Aretaieio" Hospital, Athens, Greece.
Abstract
OBJECTIVE: To determine the performance of maternal characteristics, Doppler and a set of biochemical markers for pre-eclampsia (PE) screening at 11+0 to 13+6 and 20+1 to 25+6 weeks' gestation. STUDY DESIGN: Prospectively enrolled women at 11+0 to 13+6 and 20+1 to 25+6 weeks. Maternal characteristics, uterine artery pulsatility index (UtA-PI), ductus venosus pulsatility index (DV-PI) and serum biomarkers including pregnancy associated plasma protein - A (PAPP-A), placental growth factor (PlGF), soluble fms-like tyrosine kinase 1 (sFlt-1), s-Flt-1/PLGF ratio, asymmetric dimethylarginine (ADMA), matrix metalloproteinase 9 (MMP-9), neutrophil gelatinase-associated lipocalin (NGAL) and MMP-9/NGAL complex were recorded. RESULTS: Combination of NGAL and BMI in a logistic regression model detected 70% of PE in the first trimester (p=0.001). Including UtA-PI and DV-PI in the model sensitivity reached 77.8% with 96.6% specificity (p=0.004). Combination of second trimester NGAL and s-Flt-1/PLGF ratio yield specificity 100% (p=0.001). Combination of second trimester UtA-PI with first trimester NGAL, BMI and age detected 80% of PE with specificity 91.9% (p=0.001). CONCLUSION: Combination of NGAL, maternal characteristics and Doppler parameters in the first and/or second trimester can detect a consistent number of PE pregnancies. NGAL is a potent new biomarker for the prediction of preeclampsia.
OBJECTIVE: To determine the performance of maternal characteristics, Doppler and a set of biochemical markers for pre-eclampsia (PE) screening at 11+0 to 13+6 and 20+1 to 25+6 weeks' gestation. STUDY DESIGN: Prospectively enrolled women at 11+0 to 13+6 and 20+1 to 25+6 weeks. Maternal characteristics, uterine artery pulsatility index (UtA-PI), ductus venosus pulsatility index (DV-PI) and serum biomarkers including pregnancy associated plasma protein - A (PAPP-A), placental growth factor (PlGF), soluble fms-like tyrosine kinase 1 (sFlt-1), s-Flt-1/PLGF ratio, asymmetric dimethylarginine (ADMA), matrix metalloproteinase 9 (MMP-9), neutrophil gelatinase-associated lipocalin (NGAL) and MMP-9/NGAL complex were recorded. RESULTS: Combination of NGAL and BMI in a logistic regression model detected 70% of PE in the first trimester (p=0.001). Including UtA-PI and DV-PI in the model sensitivity reached 77.8% with 96.6% specificity (p=0.004). Combination of second trimester NGAL and s-Flt-1/PLGF ratio yield specificity 100% (p=0.001). Combination of second trimester UtA-PI with first trimester NGAL, BMI and age detected 80% of PE with specificity 91.9% (p=0.001). CONCLUSION: Combination of NGAL, maternal characteristics and Doppler parameters in the first and/or second trimester can detect a consistent number of PE pregnancies. NGAL is a potent new biomarker for the prediction of preeclampsia.