177: Metabolomic biomarkers in midtrimester maternal plasma can accurately predict the development of preeclampsia

Abstract

Early identification of patients at risk of developing preeclampsia (PE) would allow providers to tailor their prenatal management and adopt preventive strategies, such as low-dose aspirin. This study investigates the ability of metabolomic biomarkers in mid-trimester maternal plasma to predict PE. In the mid-trimester study population, a case-control study was conducted including 33 pregnant women with mid-trimester maternal plasma (gestational age [GA], 16-24 weeks) who subsequently developed PE and 66 GA-matched controls with normal outcomes. Mid-trimester maternal plasma was comprehensively profiled for primary metabolomic and lipidomic signatures using gas chromatography time-of-flight mass spectrometry and liquid chromatography Orbitrap mass spectrometry. In the at-delivery study population, a retrospective cohort study was conducted using plasma samples collected from women who were delivered in the late preterm period for PE(n=13) or other causes(n=21), and the metabolomic biomarkers in maternal plasma collected at delivery were compared based on the indication of delivery. Performance of the metabolomic panel was compared also to soluble fms-like tyrosine kinase-1(sFlt-1) and placental growth factor(PlGF) in maternal plasma. In the mid-trimester study population, 329 metabolites were identified and semi-quantitated. Binary logistic regression analysis proposed a mid-trimester biomarker panel for the prediction of PE with five metabolites (SM C28:1, SM C30:1, lysoPC C19:0, lysoPE C20:0, propane-1,3-diol). This metabolomic model predicted PE better than PlGF alone (AUC=0.87[95% CI, 0.78-0.93] vs 0.65[0.55-0.74]; p< 0.005) (Figure) or sFlt-1/PlGF ratio (data not shown). In the at-delivery study population, we confirmed the ability of this biomarker panel to distinguish PE from non-PE, with comparable discrimination power to that of sFlt-1/PlGF ratio (data not shown). Integrative metabolomic biomarker panel in mid-trimester maternal plasma can accurately predict the subsequent development of PE, and also showed good discriminatory power at the time of delivery.