Abstract
PurposeOxidative stress is involved in the pathogenesis of hypertensive disorders such as preeclampsia (PE) and associated with the human vitamin E-binding protein afamin. The aim of this study was, therefore, to analyse afamin in the first trimester of patients developing PE later in pregnancy and in control subjects without pregnancy complications.MethodsIn this retrospective study, 137 serum samples from the first trimester of pregnancy were analysed in a case–control study design. 39 patients developed PE (10 patients with early-onset and 29 patients with late onset disease) and 98 women had an uncomplicated pregnancy. Mann–Whitney U test, t test, logistic regression and ROC analyses were performed for statistical evaluation.ResultsPregnant women developing PE presented with higher afamin concentrations in the first trimester [median 101.81 mg/L; interquartile range (IQR) 88.94–113.26] compared to subjects with uncomplicated pregnancy (median 86.40; IQR 75.26–96.92; p < 0.001). After adjusting for confounders, the odds ratio per afamin standard deviation was 1.60 (95% CI: 1.04–2.58; p = 0.04). An afamin threshold concentration of 87.8 mg/L exhibited the best sensitivity (79.5%) and specificity (57.1%) in predicting PE. Subgroup analysis of early- and late-onset disease resulted in substantially higher afamin concentrations in women with developing late-onset PE compared to controls (p < 0.001) with an odds ratio per afamin standard deviation of 1.62 (95% CI: 0.98–2.70; p = 0.06).ConclusionsSerum afamin concentrations are elevated in the first trimester among patients developing PE compared to controls. Substantial differences were observed mainly among patients with late-onset PE.
Highlights
Preeclampsia (PE) and other hypertensive disorders during pregnancy occur in ~ 2–8% of pregnant women [1]
Median serum afamin concentrations during the first trimester in patients developing PE were significantly higher (median 101.81 mg/L; interquartile range (IQR) 88.94–113.26) than those in the control group (Fig. 1). After adjusting this difference for gestational age at blood sampling and body mass index (BMI), afamin concentrations remained higher in patients developing PE than in the control group [odds ratio per afamin standard deviation: 1.60]
Receiver operating characteristic (ROC) analysis showed that a serum afamin concentration of 87.8 mg/L had the best sensitivity (79.5%) and specificity (57.1%) to discriminate between women in whom PE will develop during their pregnancy and those with uncomplicated pregnancy
Summary
Preeclampsia (PE) and other hypertensive disorders during pregnancy occur in ~ 2–8% of pregnant women [1]. The occurrence of placental disorders can be prevented by the administration of Aspirin® before the 16th week of pregnancy in women with clinical risk factors for PE such as pathological Doppler indices, positive family history or with PE in a previous pregnancy [2] as well as in primigravidae screened to be at high risk [3]. The prediction [4] as well as prevention [2, 3] of early-onset PE is much more successful compared to the late-onset form suggesting different pathophysiological mechanisms [6]. Reliable tools have been established to screen and prevent early-onset PE, whereas the late-onset form still needs further research regarding prediction and prevention
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