P 35 First trimester maternal serum neutrophil gelatinase-associated lipocalin (NGAL) in prediction of preeclampsia in nulliparous women

Abstract

Introduction Neutrophil gelatinase-associated lipocalin (NGAL) is a 25-kDA glycoprotein and a marker of endothelial damage. Pregnancies complicated by preeclampsia (PE) are characterized by placental insufficiency and endothelial dysfunction. Its speculated that NGAL is elevated in pregnancies with PE. Objectives To establish first trimester maternal serum NGAL concentration in normal pregnancies and in pregnancies complicated by PE. Furthermore, to evaluate the screening performance for PE. Material and methods Case-cohort study based on a cohort of nulliparous women consecutively enrolled into the first trimester combined screening programme for trisomy 21. The NGAL concentration was measured in cases with late-onset (GA ⩾ 37 weeks + 0 days) PE (n = 213), early-onset (GA Results Serum samples were drawn at a median gestational age of 11 weeks + 0 days (range 8 weeks + 1 day – 13 weeks + 5 days). The NGAL concentration was not correlated with gestational age (r = 0.07, p = 0.14), but correlated very weakly with maternal weight (r = 0.12, p = 0.01). The median NGAL concentration in controls was 68.0 ng/mL (IQR 38.5 ng/mL). The NGAL concentration was significantly elevated in cases with early-onset PE (median 78.0 ng/mL, IQR 50 ng/mL, p = 0.04). In contrast, no significant change was found in cases with late-onset PE (median 69.0 ng/mL, IQR 49.5 ng/mL, p = 0.07). The detection rate was 15% for a 10% false positive rate in screening for early-onset PE. The area under the ROC curve was 0.59. Conclusion First trimester maternal serum NGAL is not correlated with gestational age. NGAL is significantly elevated in pregnancies that develop early-onset PE. In contrast, NGAL is unchanged in cases with late-onset PE. Screening performance for early-onset PE is poor.