title: First-trimester maternal serum matrix metalloproteinase-9 (MMP-9) and adverse pregnancy outcome.
abstract: OBJECTIVE
  To investigate the potential value of maternal serum matrix metalloproteinase-9 (MMP-9) in first-trimester screening for preeclampsia and spontaneous early preterm delivery.
  
  
  METHODS
  The concentrations of MMP-9, tumour necrosis factor soluble receptor-1 (TNF-R1), pregnancy-associated plasma protein-A (PAPP-A) and uterine artery pulsatility index (UA-PI) were measured at 11(+0) - 13(+6) weeks in cases of preeclampsia (n = 128), gestational hypertension (n = 88), small for gestational age (n = 296), spontaneous early preterm delivery (n = 57) and controls (n = 569). The distributions of measured metabolites and UA-PI in the control and adverse outcome groups were compared. Logistic regression analysis was used to determine the significant contributors in the prediction of adverse outcomes.
  
  
  RESULTS
  The median MMP-9 was higher than controls in the preeclampsia (1.190 MoM) and preterm delivery (1.187 MoM) groups. In the preeclampsia group there was a significant association between serum MMP-9 and TNF-R1 (r = 0.523, P < 0.0001). Significant prediction of preeclampsia was provided by history and UA-PI, and prediction of preterm delivery was provided by history and neither was improved by the addition of MMP-9.
  
  
  CONCLUSIONS
  In pregnancies developing preeclampsia, the increased level of MMP-9 and the good correlation with TNF-R1 suggest the presence of an underlying inflammatory process. In the pregnancies resulting in spontaneous preterm delivery the small increase in MMP-9 is not useful in the prediction of preterm delivery.
authors.affiliation: Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
authors.forename: Leona C Y
authors.initials: LC
authors.lastname: Poon
authors.forename: Ekaterina
authors.initials: E
authors.lastname: Nekrasova
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Anastassopoulos
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Livanos
authors.forename: Kypros H
authors.initials: KH
authors.lastname: Nicolaides
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D020780:Matrix Metalloproteinase 9 / Q000097:blood*; D008875:Middle Aged; D011225:Pre-Eclampsia / Q000097:blood*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011261:Pregnancy Trimester, First / Q000097:blood*; D011266:Pregnancy-Associated Plasma Protein-A / Q000032:analysis; D047928:Premature Birth / Q000175:diagnosis; D047888:Receptors, Tumor Necrosis Factor, Type I / Q000097:blood; D055815:Young Adult
chemical_list: D015415:Biomarkers; D047888:Receptors, Tumor Necrosis Factor, Type I; D011266:Pregnancy-Associated Plasma Protein-A; D020780:Matrix Metalloproteinase 9