title: Racial-ethnic differences in midtrimester maternal serum levels of angiogenic and antiangiogenic factors.
abstract: Little is known about racial-ethnic differences in the distribution of maternal serum levels of angiogenic and antiangiogenic factors and their associations with early-onset preeclampsia.
  
  
  
  We sought to investigate the distribution of midtrimester maternal serum levels of placental growth factor, soluble endoglin, and soluble vascular endothelial growth factor receptor 1 and their associations with early-onset preeclampsia in whites, Hispanics, and blacks.
  
  
  
  A population-based nested case-control design was used to identify cases and controls of white, Hispanic, and black origin from a 2000 through 2007 live-birth cohort in 5 southern California counties. Cases included 197 women (90 whites, 67 Hispanics, and 40 blacks) with early-onset preeclampsia defined as hypertension and proteinuria with onset <32 weeks according to hospital records. Controls included a random sample of 2363 women without early-onset preeclampsia. Maternal serum specimens collected at 15-20 weeks' gestation as part of routine prenatal screening were tested for placental growth factor, soluble endoglin, and soluble vascular endothelial growth factor receptor 1. Serum levels of the 3 factors were log-normally distributed. Adjusted natural logarithmic means were compared between cases and controls and between racial-ethnic groups. Odds ratios and 95% confidence intervals derived from logistic regression models were calculated to measure the magnitude of the associations.
  
  
  
  Cases showed lower adjusted logarithmic means of placental growth factor but higher adjusted logarithmic means of soluble endoglin than controls across all 3 groups (P < .05). Cases also had higher adjusted means of soluble vascular endothelial growth factor receptor 1 than controls in whites (7.75 vs 7.52 log pg/mL, P < .05) and Hispanics (7.73 vs 7.40 log pg/mL, P < .05) but not in blacks (7.85 vs 7.69 log pg/mL, P = .47). Blacks were found to have higher levels of placental growth factor in both cases and controls when compared to whites and Hispanics (adjusted means: 4.69 and 5.20 log pg/mL in blacks, 4.08 and 4.78 log pg/mL in whites, and 3.89 and 4.70 log pg/mL in Hispanics, respectively, P < .05). Hispanic cases had the highest adjusted mean of soluble endoglin compared to white and black cases (9.24, 9.05, and 8.93 log pg/mL, respectively, P < .05). The weakest association of early-onset preeclampsia with placental growth factor and soluble endoglin was observed in blacks. The adjusted odds ratio per log pg/mL increase of the 2 analytes were 0.219 (95% confidence interval, 0.124-0.385) and 5.02 (95% confidence interval, 2.56-9.86) in blacks in comparison to 0.048 (95% confidence interval, 0.026-0.088) and 36.87 (95% confidence interval, 17.00-79.96) in whites (P < .05) and 0.028 (95% confidence interval, 0.013-0.060) and 86.68 (95% confidence interval, 31.46-238.81) in Hispanics (P < .05), respectively. As for soluble vascular endothelial growth factor receptor 1, the association was not significantly different among the racial-ethnic groups.
  
  
  
  Racial-ethnic differences were observed in the distribution of midtrimester maternal levels of placental growth factor and soluble endoglin and in the associations with early-onset preeclampsia. These differences should be considered in future studies to improve etiologic and prognostic understanding of early-onset preeclampsia.
authors.affiliation: Genetic Disease Screening Program, California Department of Public Health, Richmond, CA. Electronic address: juan.yang@cdph.ca.gov.
authors.forename: Juan
authors.initials: J
authors.lastname: Yang
authors.affiliation: Sequoia Foundation, Richmond, CA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Pearl
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, CA.
authors.forename: Gerald N
authors.initials: GN
authors.lastname: DeLorenze
authors.affiliation: Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Detroit, MI.
authors.forename: Roberto
authors.initials: R
authors.lastname: Romero
authors.affiliation: Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Detroit, MI.
authors.forename: Zhong
authors.initials: Z
authors.lastname: Dong
authors.affiliation: Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA.
authors.forename: Laura
authors.initials: L
authors.lastname: Jelliffe-Pawlowski
authors.affiliation: Genetic Disease Screening Program, California Department of Public Health, Richmond, CA.
authors.forename: Robert
authors.initials: R
authors.lastname: Currier
authors.affiliation: Genetic Disease Screening Program, California Department of Public Health, Richmond, CA.
authors.forename: Monica
authors.initials: M
authors.lastname: Flessel
authors.affiliation: Environmental Health Investigations Branch, California Department of Public Health, Richmond, CA.
authors.forename: Martin
authors.initials: M
authors.lastname: Kharrazi
mesh_terms: D000328:Adult; D002140:California / Q000453:epidemiology; D016022:Case-Control Studies; D000071063:Endoglin / Q000097:blood*; D005260:Female; D006801:Humans; D000072483:Placenta Growth Factor / Q000097:blood*; D011225:Pre-Eclampsia / Q000097:blood* / Q000208:ethnology; D011247:Pregnancy; D011262:Pregnancy Trimester, Second / Q000097:blood; D044469:Racial Groups / Q000706:statistics & numerical data*; D040281:Vascular Endothelial Growth Factor Receptor-1 / Q000097:blood*
chemical_list: D000071063:Endoglin; D000072483:Placenta Growth Factor; D040281:Vascular Endothelial Growth Factor Receptor-1
keywords: early-onset preeclampsia; placental growth factor; racial-ethnic differences; soluble endoglin; soluble vascular endothelial growth factor receptor-1