title: Use of first or second trimester serum markers, or both, to predict preeclampsia.
abstract: OBJECTIVE
  Preeclampsia is a serious complication of pregnancy, threatening fetal and maternal health. The aim of our study is to examine the association between preeclampsia and biochemical markers, in matched first and second trimester maternal serum samples.
  
  
  METHODS
  This is a nested case/control study derived from the cohort of pregnancies delivering at Women & Infants Hospital. Cases were identified at a clinic or by hospital codes, and individually confirmed by record review. Stored samples were available from 'integrated' Down syndrome screening. Results were expressed as multiples of the median (MoM).
  
  
  METHODS
  Preeclampsia was classified as early/severe, late/severe, or mild based on professional guidelines. An additional adverse outcome group had only gestational hypertension.
  
  
  RESULTS
  Ninety-eight cases were each matched with five control pregnancies. Population distribution parameters and within and between trimester correlations were derived for cases and controls for six markers, as well as in case subgroups. The strongest associations were for early/severe preeclampsia with second trimester PAPP-A (rank sum test 2.30, p<0.01); PlGF (2.60, p<0.05) inhibin A (4.45, p<0.05) and endoglin (4.25, p<0.05). No strong associations were found for sVEGF-R and FLRG. Second trimester associations were stronger than those in the first (e.g., PAPP-A 2.45, p<0.01). No between-trimester associations were found that would provide important improvements in prediction.
  
  
  CONCLUSIONS
  This matched analysis of the serum markers in early pregnancy allows for direct comparison of first and second trimester associations with preeclampsia. PAPP-A and PlGF are equally and highly predictive of early/severe preeclampsia.
authors.affiliation: Department of Pathology and Laboratory, Medicine Women and Infants Hospital and the Alpert Medical School at Brown University, 70 Elm Street, Providence, RI 02903, USA. Electronic address: gmesserlian@wihri.org.
authors.forename: Geralyn
authors.initials: G
authors.lastname: Lambert-Messerlian
authors.affiliation: Department of Pathology and Laboratory, Medicine Women and Infants Hospital and the Alpert Medical School at Brown University, 70 Elm Street, Providence, RI 02903, USA. Electronic address: eeklund@wihri.org.
authors.forename: Elizabeth E
authors.initials: EE
authors.lastname: Eklund
authors.affiliation: Division of Maternal Fetal Medicine, MetroHealth Medical Center, Case Western Reserve University, 2500 Metrohealth Drive, Cleveland, OH 44109, USA. Electronic address: echien@metrohealth.org.
authors.forename: Edward K
authors.initials: EK
authors.lastname: Chien
authors.affiliation: Obstetric Medicine, Lifespan Hospitals and the Alpert Medical School at Brown University, 593 Eddy Street, Providence, RI 02905, USA. Electronic address: karen_rosene_montella@brown.edu.
authors.forename: Karen
authors.initials: K
authors.lastname: Rosene-Montella
authors.affiliation: Department of Pathology and Laboratory, Medicine Women and Infants Hospital and the Alpert Medical School at Brown University, 70 Elm Street, Providence, RI 02903, USA. Electronic address: lneveux@ipmms.org.
authors.forename: Louis M
authors.initials: LM
authors.lastname: Neveux
authors.affiliation: Institute of Preventive Medicine and Medical Screening, 35 Main Street, Unit 1, Windham, ME 04062, USA. Electronic address: hamishh@ipmms.org.
authors.forename: Hamish R M
authors.initials: HR
authors.lastname: Haddow
authors.affiliation: Department of Pathology and Laboratory, Medicine Women and Infants Hospital and the Alpert Medical School at Brown University, 70 Elm Street, Providence, RI 02903, USA. Electronic address: gpalomaki@ipmms.org.
authors.forename: Glenn E
authors.initials: GE
authors.lastname: Palomaki
keywords: Endoglin; Inhibin A; PAPP-A; PlGF; Preeclampsia