Biochemical Markers for Prediction of Hypertensive Disorders of Pregnancy Translated title: BIOHEMIJSKI MARKERI ZA PREDIKCIJU HIPERTENZIVNIH POREMEĆAJA U TRUDNOĆI

Summary

Background

Gestational hypertension (GH) and pre eclampsia (PE) are the most common gestational complications. Several placental biochemical markers are used to predict GH/PE, but with conflicting results.

Methods

The study aim was to estimate the biochemical markers’ ability to predict hypertensive disorders in pregnancy. On the first ultrasonographic examination, 104 healthy pregnant women were recruited. At the regular pregnancy check-ups, BMI, blood pressure, occurrence of gestational hypertension (early or late onset), preeclampsia, eclampsia and other complications were recorded. Serum concentrations (in multiples of median – MoM) of human chorionic gonadotropin (HCG) and pregnancyassociated plasma protein A (PAPPA) were measured from the 11th to 14th gestational week, while HCG, alpha feto protein (AFP), estriol and inhibin were determined between the 16th and 19th gestational week.

Results

Hypertensive disorders throughout pregnancy were diagnosed in 20.2% women. Early-onset GH was registered in 7 and PE in 6 patients, while 14 had late-onset GH and 10 additional women PE. There were no significant differences (p≥0.05) in biochemical markers concentrations between women with and without GH/PE. PAPPA levels in the first and HCG in the second trimester correlated with early and late GH/PE. Moreover, higher AFP concentrations were registered in women with preeclampsia signs/symptoms. According to ROC analysis, AFP>1.05 MoM properly identified 80% of GH/PE cases. Obtained models imply that HCG, PAPPA and AFP should be used for GH/PE prediction.

Conclusions

Biochemical markers HCG, PAPPA and AFP could be useful in predicting gestational hypertension and preeclampsia. However, different markers should be used for early and late onset GH/PE.

Kratak sadržaj

Uvod

Gestacijska hipertenzija (GH) i preeklampsija (PE) najčešće su gestacijske komplikacije. Nekoliko placentnih biohemijskih markera koristi se za predikciju GH/PE, ali sa oprečnim rezultatima.

Metode

Cilj studije bila je procena mogućnosti korišćenja biohemijskih markera za predikciju hipertenzivnih poremećaja u trudnoći. Na prvom ultrasonografskom pregledu, u studiju su uvrštene 104 zdrave trudnice. Na redovnim pregledima tokom trudnoće registrovani su ITM, krvni pritisak, pojava gestacijske hipertenzije (rani ili kasni početak), preeklampsija, eklampsija i druge komplikacije. Serumske kon centracije (izražene u umnošcima medijane – MOM) humanog horionskog gonadotropina (HCG) i plazma proteina vezanog za trudnoću (PAPPA) merene su u periodu od 11. do 14. gestacijske nedelje, dok su HCG, alfa feto protein (AFP), estriol i inhibin određivani između 16. i 19. nedelje.

Rezultati

Hipertenzivni poremećaji tokom trudnoće dijagnostikovani su kod 20,2% žena. Rana gestacijska hiper tenzija registrovana je kod 7, a preeklampsija kod 6 pacijentkinja, dok je kasnu gestacijsku hipertenziju imalo 14, a preeklampsiju 10 žena. Nije bilo statistički značajne razlike (p>0,05) u vrednostima biohemijskih markera kod pacijentkinja sa ili bez GH/PE. Vrednosti PAPPA u prvom i HCG-a u drugom trimestru korelirale su sa pojavom rane i kasne GH/PE. S druge strane, kod pacijentkinja sa znacima i simptomima preeklampsije registrovane su povišene koncentracije AFP-a. Prema ROC analizi, AFP > 1,05 MoM precizno identifikuje 80% slučajeva GH/PE. Dobijeni modeli podrazumevaju da HCG, PAPPA i AFP treba koristiti za predviđanje GH/PE.

Zaključak

Biohemijski markeri HCG, PAPPA i AFP mogu biti korisni u predikciji gestacijske hipertenzije i preeklampsije. Ipak, za GH/PE sa ranim i kasnim početkom trebalo bi koristiti različite markere.