Prediction of pre-eclampsia combining NGAL and other biochemical markers with Doppler in the first and/or second trimester of pregnancy. A pilot study.
OBJECTIVE
To determine the performance of maternal characteristics, Doppler and a set of biochemical markers for pre-eclampsia (PE) screening at 11+0 to 13+6 and 20+1 to 25+6 weeks' gestation.


METHODS
Prospectively enrolled women at 11+0 to 13+6 and 20+1 to 25+6 weeks. Maternal characteristics, uterine artery pulsatility index (UtA-PI), ductus venosus pulsatility index (DV-PI) and serum biomarkers including pregnancy associated plasma protein - A (PAPP-A), placental growth factor (PlGF), soluble fms-like tyrosine kinase 1 (sFlt-1), s-Flt-1/PLGF ratio, asymmetric dimethylarginine (ADMA), matrix metalloproteinase 9 (MMP-9), neutrophil gelatinase-associated lipocalin (NGAL) and MMP-9/NGAL complex were recorded.


RESULTS
Combination of NGAL and BMI in a logistic regression model detected 70% of PE in the first trimester (p=0.001). Including UtA-PI and DV-PI in the model sensitivity reached 77.8% with 96.6% specificity (p=0.004). Combination of second trimester NGAL and s-Flt-1/PLGF ratio yield specificity 100% (p=0.001). Combination of second trimester UtA-PI with first trimester NGAL, BMI and age detected 80% of PE with specificity 91.9% (p=0.001).


CONCLUSIONS
Combination of NGAL, maternal characteristics and Doppler parameters in the first and/or second trimester can detect a consistent number of PE pregnancies. NGAL is a potent new biomarker for the prediction of preeclampsia.
Second Department of Obstetrics & Gynecology, Medical School, University of Athens "Aretaieio" Hospital, Athens, Greece. Electronic address: karampasgrig@gmail.com.
Grigorios A
GA
Karampas
Second Department of Obstetrics & Gynecology, Medical School, University of Athens "Aretaieio" Hospital, Athens, Greece; "EmbryoCare", Fetal Medicine Unit, Athens, Greece.
Makarios I
MI
Eleftheriades
Second Department of Obstetrics & Gynecology, Medical School, University of Athens "Aretaieio" Hospital, Athens, Greece.
Konstantinos C
KC
Panoulis
"Diamedica SA", Clinical Chemistry Laboratory, Athens, Greece.
Myrto D
MD
Rizou
"Diamedica SA", Clinical Chemistry Laboratory, Athens, Greece.
Alexander D
AD
Haliassos
Department of Midwifery, Faculty of Health and Caring Professions, Technological Educational Institute of Athens, Athens, Greece.
Dimitra K
DK
Metallinou
Endocrine Unit, Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, University of Athens, Athens, Greece.
George P
GP
Mastorakos
Second Department of Obstetrics & Gynecology, Medical School, University of Athens "Aretaieio" Hospital, Athens, Greece; Hormone Laboratory, "Aretaieio" Hospital, Athens, Greece.
Demetrios A
DA
Rizos
D000328:Adult; D001120:Arginine / Q000031:analogs & derivatives / Q000097:blood; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D000071068:Lipocalin-2 / Q000097:blood*; D020780:Matrix Metalloproteinase 9 / Q000097:blood; D010865:Pilot Projects; D000072483:Placenta Growth Factor / Q000097:blood; D011225:Pre-Eclampsia / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D011247:Pregnancy; D011261:Pregnancy Trimester, First / Q000097:blood*; D011262:Pregnancy Trimester, Second / Q000097:blood*; D011266:Pregnancy-Associated Plasma Protein-A / Q000378:metabolism; D018617:Ultrasonography, Doppler, Pulsed; D040281:Vascular Endothelial Growth Factor Receptor-1 / Q000097:blood
D015415:Biomarkers; D000071068:Lipocalin-2; D000072483:Placenta Growth Factor; C018524:N,N-dimethylarginine; D001120:Arginine; C501162:FLT1 protein, human; D040281:Vascular Endothelial Growth Factor Receptor-1; D011266:Pregnancy-Associated Plasma Protein-A; D020780:Matrix Metalloproteinase 9
Biochemical makers; Ductus venosus pulsatility Index; First and/or second trimester screening; Neutrophil gelatinase-associated lipocalin; Pre-eclampsia; Uterine artery pulsatility index