O21. First trimester serum placental growth factor and hyperglycosylated human chorionic gonadotropin are associated with later pre-eclampsia

Abstract

Introduction First trimester serum placental growth factor (PlGF) predicts early-onset pre-eclampsia (diagnosis Objectives To study the accuracy of using combined maternal serum %hCG-h, PlGF, PAPP-A and maternal risk factors in prediction of pre-eclampsia. Methods We determined gestational-age-adjusted concentrations of PlGF, PAPP-A, hCG (Perkin Elmer Wallac Oy, Turku, Finland) and hCG-h (in-house immunofluorometric assay) in maternal serum at 8–13 weeks of gestation. The study consisted of 98 women who later developed pre-eclampsia and 177 pregnant controls. Of the cases, 24 developed preterm pre-eclampsia (diagnosis 160/110mmHg, proteinuria>5g/24h and/or hemolysis, elevated liver enzymes and low platelet count –syndrome). Results Serum PlGF, %hCG-h and PAPP-A were lower in women with later preterm or severe pre-eclampsia than in controls. In receiver-operating characteristics (ROC) curve analysis the area under the curve (AUC) was 0.680 for PlGF, 0.699 for %hCG-h and 0.714 for PAPP-A to predict preterm pre-eclampsia. AUC values for prediction of severe pre-eclampsia were 0.677, 0.702 and 0.677, respectively. When PlGF, %hCG-h and PAPP-A were combined by logistic regression analysis the AUC value was 0.830 for preterm pre-eclampsia and 0.824 for severe pre-eclampsia. Combination of PlGF, %hCG-h, PAPP-A and maternal risk factors including nulliparity and first-trimester mean arterial pressure (MAP) gave an AUC value of 0.805 for preterm pre-eclampsia and 0.882 for severe pre-eclampsia. When PlGF was removed from the analysis the AUC value was 0.803 for preterm pre-eclampsia and 0.878 for severe pre-eclampsia. When %hCG-h was removed the AUC values were 0.756 and 0.840, respectively. Conclusions Combining %hCG-h with PlGF, PAPP-A and maternal risk factors in first trimester improves prediction of later preterm or severe pre-eclampsia. %hCG-h tended to give better AUC values than PlGF when combined with PAPP-A and maternal risk factors. Thus, in first trimester %hCG-h might be superior to PlGF for prediction of preterm or severe pre-eclampsia and it should be further investigated in risk models of pre-eclampsia.