Risks for preeclampsia and small for gestational age: predictive values of placental growth factor, soluble fms-like tyrosine kinase-1, and inhibin A in singleton and multiple-gestation pregnancies.

OBJECTIVE: To determine the accuracy of placental growth factor (PlGF), soluble fms-like tyrosine kinase-1 (sFlt-1), and inhibin A in singleton and multiple-gestation pregnancies for predicting preeclampsia (PE) and small for gestational age (SGA). STUDY DESIGN: A prospective cohort nested in a randomized controlled trial of antioxidant supplementation for the prevention of PE. Plasma biomarkers were evaluated at 12 to 18 (visit 1) and 24 to 26 (visit 2) weeks' gestation and expressed as adjusted multiples of the median. RESULTS: Multiple-gestation pregnancy (74/772) had a significant impact on all biomarkers' levels. PlGF was the best predictor of PE and SGA. At a 10% false-positive rate, PlGF at visit 1 had 21% sensitivity for predicting PE in singleton versus 60% in multiple-gestation pregnancies. PlGF at visit 1 had a 31% sensitivity in singleton and 27% in multiple-gestation pregnancies for SGA prediction. CONCLUSION: PlGF level was a good predictor of subsequent PE as early as 12 to 18 weeks in multiple-gestation pregnancies but was not clinically useful enough to be used as a single marker.

Endostatin levels and the risk of subsequent preeclampsia.

OBJECTIVE: To evaluate endostatin, an anti-angiogenic factor, in relation to the risk of preeclampsia (PE). STUDY DESIGN: In this case control study, serum samples were collected at 11-17 weeks and 18-26 weeks' gestation. Endostatin levels were expressed as adjusted multiples of the median (MoM). Logistic regression was used to calculate adjusted odds ratios (aORs) for the prediction of PE. RESULTS: A total of 77 women with PE and 150 controls were studied. Endostatin levels were significantly higher in women with PE compared to controls in both the first and the second trimester. At a cut-off level of 75th percentile of endostatin MoMs, the aORs for PE were 1.33 (95% confidence interval [CI], 0.68-2.58) at 11-17 weeks and 1.77 (95% CI, 0.94-3.34) at 18-26 weeks, after adjustment for ethnicity and chronic hypertension. The aORs for early-onset PE were 3.51 (95% CI, 1.18-10.43) at 11-17 weeks and 2.17 (95% CI, 0.67-7.06) at 18-26 weeks. CONCLUSIONS: Higher endostatin levels are associated with an increased risk of early onset PE. Endostatin alone, however, has a poor predictive value for clinical usefulness.