Adhesion molecules, activin and inhibin--candidates for the biochemical prediction of hypertensive diseases in pregnancy?
BACKGROUND
The aim of the prospective study was to compare standard parameters as Doppler ultrasound and 24-h blood pressure measurement with possible maternal serological markers regarding their prognostic value in predicting hypertensive diseases in pregnancy.


METHODS
Twenty-four-hour blood pressure measurement was performed before and after 32+0 gestational week in 57 pregnant women with either chronic hypertension ( n=13), preeclampsia ( n=21), pregnancy-induced hypertension (PIH; n=12) or normotension ( n=11). Blood samples were taken and the concentrations of soluble intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), activin A and inhibin A were determined as well as serum uric acid, creatinine, total serum protein and serum albumin. Doppler ultrasound of the uterine arteries was examined before 32+0 gestational week in the same patients. For the statistical evaluation Kruskal-Wallis-Test and Mann-Whitney-U-Test were performed. Differences in the predictive value were evaluated by receiver-operating characteristics.


RESULTS
VCAM-1 was significantly elevated in women developing hypertensive diseases as compared to normotensive women (preeclampsia: p<0.001; PIH: p<0.05; chronic hypertension: p<0.001). In early pregnancy activin A and inhibin A were significantly higher in preeclamptic patients than in the other groups (activin A: normotension: p<0.005; PIH: p<0.001; chronic hypertension: p<0.005) (inhibin A: normotension: p<0.005; PIH: p<0.001; chronic hypertension: p<0.01), thus suggesting them to be specific markers for the development of preeclampsia. Mean arterial pressure was significantly elevated in preeclampsia ( p<0.001) and chronic hypertension ( p<0.005) as compared to normotensives.


CONCLUSIONS
Twenty-four-hour blood pressure monitoring with determination of mean arterial pressure and measurement of VCAM-1, activin A and inhibin A as serum parameters can be suggested as useful tests in the specific prediction of different types of hypertensive diseases in pregnancy.
Hanisch
Claudia G
CG
Department of Obstetrics and Gynecology, University Hospital, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany.
Pfeiffer
Kerstin A
KA
Schlebusch
Harald
H
Schmolling
Jan
J
D028341:Activins / Q000097:blood*; D000328:Adult; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure / Q000502:physiology; D018660:Blood Pressure Monitoring, Ambulatory; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000175:diagnosis*; D046110:Hypertension, Pregnancy-Induced / Q000097:blood / Q000175:diagnosis; D028322:Inhibin-beta Subunits / Q000097:blood*; D007265:Inhibins / Q000097:blood*; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood; D011225:Pre-Eclampsia / Q000097:blood / Q000175:diagnosis; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000097:blood / Q000175:diagnosis*; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D014465:Ultrasonics; D019010:Vascular Cell Adhesion Molecule-1 / Q000097:blood*
D015415:Biomarkers; D019010:Vascular Cell Adhesion Molecule-1; C422405:activin A; C422362:inhibin A; D028341:Activins; D018799:Intercellular Adhesion Molecule-1; D007265:Inhibins; D028322:Inhibin-beta Subunits