Preeclampsia in high risk women is characterized by risk group-specific abnormalities in serum biomarkers.
OBJECTIVE
To determine if early pregnancy serum biomarkers in high-risk women who develop preeclampsia vary according to risk factor.


METHODS
We performed a secondary analysis of the Maternal-Fetal Medicine Units Network randomized controlled trial of low-dose aspirin for the prevention of preeclampsia in high-risk women. Serum biomarker levels at enrollment (before initiation of aspirin or placebo) were compared between women who did and did not develop preeclampsia, both for the group as a whole and within each of 4 high-risk groups (insulin-dependent diabetes, hypertension, multiple gestation, and previous preeclampsia) using a regression model adjusting for gestational age at collection and prepregnancy body mass index.


RESULTS
1258 women were included (233 with insulin-dependent diabetes, 387 with chronic hypertension, 315 with a multiple gestation, 323 with previous preeclampsia). Multiple early pregnancy serum biomarkers differed between women who did and did not develop preeclampsia. Each high-risk group had a unique and largely nonoverlapping pattern of biomarker abnormality. Differences between those who did and did not develop preeclampsia were noted in vascular cell adhesion molecule in the diabetes group; human chorionic gonadotropin, soluble tumor necrosis factor receptor-2, tumor necrosis factor-alpha, selectin and angiogenin in the chronic hypertension group; interleukin-6, placental growth factor, soluble fms-like tyrosine kinase plus endoglin to placental growth factor ratio in the multiple gestation group; and angiogenin in the previous preeclampsia group.


CONCLUSIONS
Patterns of serum biomarkers vary by high-risk group. These data support the hypothesis that multiple pathogenic pathways lead to the disease recognized clinically as preeclampsia.
University of Colorado Denver, Department of Obstetrics and Gynecology, Aurora, CO; Denver Health Medical Center, Department of Obstetrics and Gynecology, Denver, CO.
Torri D
TD
Metz
University of Colorado School of Public Health, Aurora, CO.
Amanda A
AA
Allshouse
University of Colorado Denver, Department of Obstetrics and Gynecology, Aurora, CO.
Anna G
AG
Euser
University of Colorado Denver, Department of Obstetrics and Gynecology, Aurora, CO; Denver Health Medical Center, Department of Obstetrics and Gynecology, Denver, CO.
Kent D
KD
Heyborne
D000328:Adult; D015703:Antigens, CD / Q000097:blood; D015415:Biomarkers / Q000097:blood; D006063:Chorionic Gonadotropin / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000097:blood*; D000071063:Endoglin; D005260:Female; D006801:Humans; D006973:Hypertension / Q000097:blood*; D000072483:Placenta Growth Factor; D011225:Pre-Eclampsia / Q000097:blood*; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000097:blood*; D011257:Pregnancy Proteins / Q000097:blood; D011254:Pregnancy in Diabetics / Q000097:blood*; D011272:Pregnancy, Multiple / Q000097:blood*; D011374:Progesterone / Q000097:blood; D011956:Receptors, Cell Surface / Q000097:blood; D047889:Receptors, Tumor Necrosis Factor, Type II / Q000097:blood; D012259:Ribonuclease, Pancreatic / Q000097:blood; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D014409:Tumor Necrosis Factor-alpha / Q000097:blood; D040281:Vascular Endothelial Growth Factor Receptor-1 / Q000097:blood; D055815:Young Adult
D015703:Antigens, CD; D015415:Biomarkers; D006063:Chorionic Gonadotropin; C064206:ENG protein, human; D000071063:Endoglin; C000608036:PGF protein, human; D011257:Pregnancy Proteins; D011956:Receptors, Cell Surface; D047889:Receptors, Tumor Necrosis Factor, Type II; D014409:Tumor Necrosis Factor-alpha; D000072483:Placenta Growth Factor; D011374:Progesterone; C501162:FLT1 protein, human; D040281:Vascular Endothelial Growth Factor Receptor-1; C046366:angiogenin; D012259:Ribonuclease, Pancreatic
biomarkers; diabetes; hypertension; multiple gestation; preeclampsia