Maternal plasma fibronectin and advanced oxidative protein products for the prediction of preeclampsia in high risk pregnancies: a prospective cohort study.

ABSTRACT

OBJECTIVE: To determine whether maternal plasma fibronectin and advanced oxidative protein products (AOPP) can be used for the prediction of preeclampsia in high-risk women. STUDY DESIGN: One hundred pregnant women at high risk of preeclampsia were enrolled in this prospective cohort study. Maternal plasma total fibronectin and AOPP levels were measured at 19-25 weeks of gestation. AOPP levels were also measured in 23 normal non-pregnant women. After delivery, the pregnant cohort was assigned to either the normotensive or preeclamptic group depending on their clinical course. RESULTS: Among the 78 pregnant women who completed the study, 19 (24.3%) developed preeclampsia between 36 and 39 (36.8 +/- 1.0) weeks of gestation. AOPP levels, which are significantly higher in normotensive pregnant women compared to nonpregnant controls (42.55 +/- 15.94 vs. 27.95 +/- 10.5; p = 0.0001) were not significantly different between normotensive and preeclamptic women (42.55 +/- 15.94 vs. 47.45 +/- 14.19 microM; p = 0.23). Plasma fibronectin levels were significantly higher in women who continued to develop preeclampsia rather than remain normotensive (383.68 +/- 19.07 vs. 227.65 +/- 97.39; p < 0.0001). ROC curve analysis shows that total fibronectin >or=360 mg/l is predictive for the development of preeclampsia. The sensitivity, specificity, positive and negative predictive values are 57, 92, 73 and 85%, respectively, with a likelihood ratio of 7.38. CONCLUSION: Second trimester plasma concentrations of AOPP are not altered in women that develop pre-eclampsia later in pregnancy. However, total fibronectin levels are significantly increased and may be used to predict the onset of clinical symptoms of preeclampsia.