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Prediction of Preeclampsia by Combining Serum Histidine-Rich Glycoprotein and Uterine Artery Doppler
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi. (Obstetrisk forskning/Axelsson)
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi. (Obstetrisk forskning/Axelsson)
Department of Clinical Science and Education, Section of Obstetrics and Gynecology, Karolinska Institute, Södersjukhuset, Stockholm, Sweden.
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk biokemi och mikrobiologi.
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2012 (Engelska)Ingår i: American Journal of Hypertension, ISSN 0895-7061, E-ISSN 1941-7225, Vol. 25, nr 12, s. 1305-1310Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background

Preeclampsia is associated with both maternal and perinatal morbidity and mortality. Histidine-rich glycoprotein (HRG) is a protein interacting with angiogenesis, coagulation, and inflammatory responses, processes known to be altered in preeclamptic pregnancies. Significantly lower levels of HRG have been demonstrated as early as in the first trimester in women later developing preeclampsia compared with normal pregnancies. The aim of this study was to investigate whether the combination of HRG and uterine artery Doppler ultrasonography can be used as a predictor of preeclampsia.

Methods

A total of 175 women were randomly selected from a case-control study; 86 women had an uncomplicated pregnancy and 89 women later developed preeclampsia. Blood samples and pulsatility index (PI) were obtained from both cases and controls in gestational week 14.

Results

HRG levels were significantly lower in women who developed preterm preeclampsia compared with controls, but not for women developing preeclampsia in general. PI was significantly higher in the preeclampsia group compared with controls, especially in preterm preeclampsia. The combination of HRG and PI revealed a sensitivity of 91% and a specificity of 62% for preterm preeclampsia.

Conclusions

The combination of HRG and uterine artery Doppler may predict preterm preeclampsia in early pregnancy.

Ort, förlag, år, upplaga, sidor
2012. Vol. 25, nr 12, s. 1305-1310
Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
URN: urn:nbn:se:uu:diva-180199DOI: 10.1038/ajh.2012.112ISI: 000311175300012PubMedID: 22895448OAI: oai:DiVA.org:uu-180199DiVA, id: diva2:548742
Tillgänglig från: 2012-08-31 Skapad: 2012-08-31 Senast uppdaterad: 2017-12-07Bibliografiskt granskad
Ingår i avhandling
1. Pre-eclampsia – Possible to Predict?: A Biochemical and Epidemiological Study of Pre-eclampsia
Öppna denna publikation i ny flik eller fönster >>Pre-eclampsia – Possible to Predict?: A Biochemical and Epidemiological Study of Pre-eclampsia
2012 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Pre-eclampsia is a major cause of maternal and perinatal morbidity and mortality worldwide. A predictor of pre-eclampsia would enable intervention, close surveillance and timely delivery, and thereby reduce the negative consequences of the disorder.

The overall aim of this thesis was to study potential predictors of pre-eclampsia by biochemical and epidemiological methods.

Angiopoietin-1 (Ang-1) and Angiopoietin-2 (Ang-2) are regulators of angiogenesis, which is important for placental development. In a prospective and longitudinal study of a low-risk population the Ang-1/Ang-2 ratio was evaluated. The Ang-1/Ang-2 ratio increased during pregnancy in all women but at gestational week 25 and 28 the ratios were significantly lower in women who later developed pre-eclampsia. The relevance of Histidine-rich glycoprotein (HRG), a protein with angiogenic properties, was furthermore evaluated. HRG levels decreased in all women, with significantly lower levels at gestational week 10, 25 and 28 in women who later developed pre-eclampsia. Thus both Ang-1/Ang-2 ratio and HRG may predict pre-eclampsia.

To evaluate the predictive value of HRG in combination with uterine artery Doppler early in pregnancy a study was performed in a high-risk population. The results revealed that the combination was better able to predict preterm pre-eclampsia than each marker individually, with a sensitivity of 91% at a specificity of 62%. 

A possible association between hyperemesis gravidarum and pre-eclampsia, as well as other placental dysfunctional disorders, was investigated. Hyperemesis gravidarum may be caused by high levels of human chorionic gonadotrophin (hCG) and increased levels of hCG in the second trimester is associated with later development of pre-eclampsia. A cohort of all pregnancies in the Swedish medical birth register between 1997 and 2009 was studied. After adjustment for confounding factors an association between hyperemesis gravidarum in the second trimester and preterm pre-eclampsia, placental abruption and infants born small for gestational age was demonstrated.

In conclusion, the ratio of Ang-1/Ang-2 as well as HRG in plasma may be potential predictors of pre-eclampsia. Combination with uterine artery Doppler further increases the predictive value of HRG for preterm pre-eclampsia. Hyperemesis gravidarum in the second trimester may be considered as a clinical risk predictor of pre-eclampsia and other placental dysfunctional disorders.

Ort, förlag, år, upplaga, sidor
Uppsala: Acta Universitatis Upsaliensis, 2012. s. 65
Serie
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 835
Nyckelord
pre-eclampsia, angiopoietin, histidine-rich glycoprotein, hyperemesis gravidarum
Nationell ämneskategori
Medicin och hälsovetenskap
Forskningsämne
Obstetrik och gynekologi
Identifikatorer
urn:nbn:se:uu:diva-183394 (URN)978-91-554-8523-8 (ISBN)
Disputation
2012-12-14, Rosénsalen, Akademiska sjukhuset ingång 95, Uppsala, 09:00 (Svenska)
Opponent
Handledare
Tillgänglig från: 2012-11-23 Skapad: 2012-10-25 Senast uppdaterad: 2013-02-11Bibliografiskt granskad

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Bolin, MarieWikström, Anna-KarinOlsson, Anna-KarinRingvall, MariaSundström-Poromaa, IngerAxelsson, OveÅkerud, Helena

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Bolin, MarieWikström, Anna-KarinOlsson, Anna-KarinRingvall, MariaSundström-Poromaa, IngerAxelsson, OveÅkerud, Helena
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Obstetrik & gynekologiInstitutionen för medicinsk biokemi och mikrobiologiCentrum för klinisk forskning i D län (CKFD)
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