title: Fetal hemoglobin, α1-microglobulin and hemopexin are potential predictive first trimester biomarkers for preeclampsia.
abstract: OBJECTIVE
  Overproduction of cell-free fetal hemoglobin (HbF) in the preeclamptic placenta has been recently implicated as a new etiological factor of preeclampsia. In this study, maternal serum levels of HbF and the endogenous hemoglobin/heme scavenging systems were evaluated as predictive biomarkers for preeclampsia in combination with uterine artery Doppler ultrasound.
  
  
  METHODS
  Case-control study including 433 women in early pregnancy (mean 13.7weeks of gestation) of which 86 subsequently developed preeclampsia. The serum concentrations of HbF, total cell-free hemoglobin, hemopexin, haptoglobin and α1-microglobulin were measured in maternal serum. All patients were examined with uterine artery Doppler ultrasound. Logistic regression models were developed, which included the biomarkers, ultrasound indices, and maternal risk factors.
  
  
  RESULTS
  There were significantly higher serum concentrations of HbF and α1-microglobulin and significantly lower serum concentrations of hemopexin in patients who later developed preeclampsia. The uterine artery Doppler ultrasound results showed significantly higher pulsatility index values in the preeclampsia group. The optimal prediction model was obtained by combining HbF, α1-microglobulin and hemopexin in combination with the maternal characteristics parity, diabetes and pre-pregnancy hypertension. The optimal sensitivity for all preeclampsia was 60% at 95% specificity.
  
  
  CONCLUSIONS
  Overproduction of placentally derived HbF and depletion of hemoglobin/heme scavenging mechanisms are involved in the pathogenesis of preeclampsia. The combination of HbF and α1-microglobulin and/or hemopexin may serve as a prediction model for preeclampsia in combination with maternal risk factors and/or uterine artery Doppler ultrasound.
authors.affiliation: Section of Obstetrics and Gynecology, Department of Clinical Sciences Lund, Lund University, Sweden; Skåne University Hospital, Malmö/Lund, Sweden. Electronic address: ulrik.dolberg_anderson@med.lu.se.
authors.forename: Ulrik Dolberg
authors.initials: UD
authors.lastname: Anderson
authors.affiliation: Department of Clinical Sciences, Lund, Infection Medicine, Lund University, Sweden.
authors.forename: Magnus
authors.initials: M
authors.lastname: Gram
authors.affiliation: Department of Clinical Sciences, RC Syd, Lund University, Sweden.
authors.forename: Jonas
authors.initials: J
authors.lastname: Ranstam
authors.affiliation: Fetal Medicine Unit, St. George's University Hospital, London, United Kingdom.
authors.forename: Basky
authors.initials: B
authors.lastname: Thilaganathan
authors.affiliation: Department of Clinical Sciences, Lund, Infection Medicine, Lund University, Sweden.
authors.forename: Bo
authors.initials: B
authors.lastname: Kerström
authors.affiliation: Section of Obstetrics and Gynecology, Department of Clinical Sciences Lund, Lund University, Sweden; Skåne University Hospital, Malmö/Lund, Sweden.
authors.forename: Stefan R
authors.initials: SR
authors.lastname: Hansson
mesh_terms: D000328:Adult; D000510:Alpha-Globulins / Q000378:metabolism*; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D005260:Female; D005319:Fetal Hemoglobin / Q000378:metabolism*; D006242:Haptoglobins / Q000378:metabolism; D006466:Hemopexin / Q000378:metabolism*; D006801:Humans; D016015:Logistic Models; D062145:Maternal Serum Screening Tests; D011225:Pre-Eclampsia / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D011247:Pregnancy; D011261:Pregnancy Trimester, First / Q000097:blood*; D012680:Sensitivity and Specificity; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal; D055988:Uterine Artery / Q000000981:diagnostic imaging
chemical_list: D000510:Alpha-Globulins; D015415:Biomarkers; C485359:HP protein, human; D006242:Haptoglobins; C016001:alpha-1-microglobulin; D006466:Hemopexin; D005319:Fetal Hemoglobin