title: Circulating Fibronectin and Plasminogen Activator Inhibitor-2 Levels as Possible Predictors of Recurrent Placental Syndrome: An Exploratory Study.
abstract: OBJECTIVE
  Placental syndromes (PS) are characterized by endothelial dysfunction complicating placental dysfunction. Possible markers for endothelial dysfunction and amount of trophoblast are fibronectin and plasminogen activator inhibitor-2 (PAI-2), respectively. We aimed (1) to determine whether in women with recurrent PS (rPS), this complication is preceded by deviating fibronectin- and PAI-2-levels, and (2) whether this is dependent on pre-pregnant plasma volume (PV).
  
  
  METHODS
  In 36 former patients, we determined fibronectin- and PAI-2-levels in blood-samples collected preconceptionally and at 12-16 weeks in their next pregnancy. Differences were analyzed between pregnancies with rPS (n = 12) and without rPS (non-rPS, n = 24) using linear mixed models, with subanalyses based on pre-pregnant normal or subnormal PV.
  
  
  RESULTS
  We observed higher fibronectin-levels at 12-16 weeks (p < 0.05 and p < 0.01, respectively) and lower PAI-2-levels at 16 weeks (p < 0.01) in the rPS subgroup, the intergroup differences being larger in women with subnormal PV.
  
  
  CONCLUSIONS
  We showed that former PS patients who developed rPS have raised fibronectin- and reduced PAI-2-levels already in early/mid pregnancy. These deviations are even more prominent in women with subnormal pre-pregnant PV, supporting development of a 2-step screening program for former patients to identify the high-risk subgroup of women who may benefit from closer surveillance.
authors.affiliation: Department of Pathology, Maastricht University Medical Centre, CAPHRI Research School, The Division 'Vrouw &amp; Baby', Maastricht, The Netherlands.
authors.forename: Carmen A H
authors.initials: CAH
authors.lastname: Severens-Rijvers
authors.forename: Salwan
authors.initials: S
authors.lastname: Al-Nasiry
authors.forename: Chahinda
authors.initials: C
authors.lastname: Ghossein-Doha
authors.forename: Sara
authors.initials: S
authors.lastname: Marzano
authors.forename: Hugo
authors.initials: H
authors.lastname: Ten Cate
authors.forename: Bjorn
authors.initials: B
authors.lastname: Winkens
authors.forename: Marc A E
authors.initials: MAE
authors.lastname: Spaanderman
authors.forename: Louis L H
authors.initials: LLH
authors.lastname: Peeters
mesh_terms: D000328:Adult; D015415:Biomarkers; D005260:Female; D005353:Fibronectins / Q000097:blood*; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D010922:Placenta Diseases / Q000209:etiology*; D017396:Plasminogen Activator Inhibitor 2 / Q000097:blood*; D011247:Pregnancy; D011264:Pregnancy Trimesters / Q000097:blood*; D012008:Recurrence; D012189:Retrospective Studies; D013577:Syndrome
chemical_list: D015415:Biomarkers; D005353:Fibronectins; D017396:Plasminogen Activator Inhibitor 2
keywords: Fibronectin; Gestational hypertension; PAI-2; Placental syndrome; Preeclampsia