The addition of activin A and inhibin A measurement to uterine artery Doppler velocimetry to improve the early prediction of pre-eclampsia.
OBJECTIVE
To evaluate whether the measurement of maternal serum activin A and inhibin A adds any clinically relevant information for the prediction of pre-eclampsia in women with altered uterine artery Doppler velocimetry at 24 weeks of gestation.


METHODS
This was a prospective, controlled, hospital-based study involving 58 asymptomatic pregnant women at 24 weeks' gestation in whom a diastolic notch of the uterine artery waveform was noted at routine Doppler examination. Doppler assessment of the uterine artery waveform and measurement of maternal activin A and inhibin A serum levels by specific two-site enzyme immunoassays were performed. The cut-off points for defining 'high' serum activin A and inhibin A levels for prediction of pre-eclampsia were chosen by receiver-operating characteristics (ROC) curve analysis. The probability of developing pre-eclampsia was calculated for several combinations of results of hormone testing.


RESULTS
Activin A and inhibin A levels were higher in patients who developed pre-eclampsia (n = 18; mean +/- standard error: 2.69 +/- 0.35 ng/mL and 131.2 +/- 22.7 pg/mL, respectively) than in those who did not present with pre-eclampsia at follow-up (n = 40; activin A: 1.79 +/- 0.18 ng/mL and inhibin A: 91.9 +/- 6.2 pg/mL; P < 0.05). Activin A at the cut-off value of 1.7 multiples of the median (MoM) achieved a sensitivity of 61% and a specificity of 89%, whereas inhibin A at the cut-off value of 1.8 MoM combined a sensitivity of 39% with a specificity of 92% for prediction of pre-eclampsia. The probability of pre-eclampsia was 31% in the whole study population, 86% if both activin A and inhibin A were elevated and 17% if both hormone markers were unaltered.


CONCLUSIONS
The measurement of serum activin A and inhibin A levels may add significant prognostic information for predicting pre-eclampsia in pregnant women showing specific Doppler alterations in the late second trimester.
Florio
P
P
Chair of Obstetrics and Gynecology, University of Siena, Siena, Italy.
Reis
F M
FM
Pezzani
I
I
Luisi
S
S
Severi
F M
FM
Petraglia
F
F
D028341:Activins / Q000097:blood*; D000328:Adult; D001783:Blood Flow Velocity; D005260:Female; D006801:Humans; D028322:Inhibin-beta Subunits / Q000097:blood*; D007265:Inhibins / Q000097:blood*; D017078:Laser-Doppler Flowmetry / Q000379:methods; D011225:Pre-Eclampsia / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D011247:Pregnancy; D011446:Prospective Studies; D012212:Rheology / Q000379:methods; D012680:Sensitivity and Specificity; D016216:Ultrasonography, Prenatal / Q000379:methods; D014599:Uterus / Q000098:blood supply*
C422405:activin A; C422362:inhibin A; D028341:Activins; D007265:Inhibins; D028322:Inhibin-beta Subunits