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First-trimester placental protein 13 screening for preeclampsia and intrauterine growth restriction
Ilana Chafetz1, Ido Kuhnreich, Marei Sammar
1Diagnostic Technologies Ltd, Haifa, Israel.
Insights
First-trimester screening for placental protein 13 (PP13) shows promise for predicting preeclampsia. Lower PP13 levels in early pregnancy are associated with increased risk of preeclampsia and intrauterine growth restriction (IUGR).
Area of Science:
- Reproductive biology
- Maternal-fetal medicine
- Biomarker discovery
Background:
- Preeclampsia and intrauterine growth restriction (IUGR) are significant complications of pregnancy.
- Early detection of these conditions is crucial for improved maternal and fetal outcomes.
- Placental protein 13 (PP13) is a protein produced by the placenta with potential as a pregnancy complication biomarker.
Purpose of the Study:
- To evaluate the efficacy of first-trimester serum placental protein 13 (PP13) levels as a screening test for preeclampsia.
- To assess PP13 as a predictor for intrauterine growth restriction (IUGR).
Main Methods:
- A prospective, nested case-control study was conducted.
- Serum PP13 levels were measured using enzyme-linked immunosorbent assay in samples from the first prenatal visit (9-12 weeks gestation).
- Cases included women with preeclampsia, IUGR, or preterm delivery; controls had uncomplicated term deliveries.
Main Results:
- Median first-trimester PP13 levels were significantly lower in women who developed preeclampsia (27.2 pg/mL), IUGR (86.6 pg/mL), and preterm delivery (84.9 pg/mL) compared to controls (132.5 pg/mL).
- PP13 multiples of the median were 0.2 for preeclampsia, 0.6 for IUGR, and 0.6 for preterm delivery (all P < .001 vs. controls).
- Receiver operating characteristic analysis showed an area under the curve of 0.91 for preeclampsia, with 90% specificity yielding 79% sensitivity.
Conclusions:
- First-trimester maternal serum PP13 screening is a promising diagnostic tool for predicting preeclampsia.
- The test demonstrates high sensitivity and specificity for preeclampsia detection.
- PP13 may also serve as a screening marker for IUGR and preterm delivery, though with lower predictive performance.
Objective:
The purpose of this study was to evaluate first-trimester serum placental protein 13 (PP13) as a screening test for preeclampsia and intrauterine growth restriction (IUGR).
Study Design:
We performed a prospective, nested case-control study in the Massachusetts General Hospital Obstetric Maternal Study. PP13 was measured by solid-phase sandwich enzyme-linked immunosorbent assay in serum samples that were collected at the first prenatal visit (9-12 weeks of gestation) from women who subsequently experienced preeclampsia (n = 47), IUGR (n = 42), or preterm delivery (n = 46). Women with uncomplicated term deliveries served as control subjects (n = 290) and were matched to cases by gestational age when serum was collected and for the duration of specimen storage.
Results:
The median first-trimester PP13 level was 132.5 pg/mL in the control subjects. Median PP13 levels were significantly lower among women who had preeclampsia (27.2 pg/mL; P < .001), IUGR (86.6 pg/mL; P < .001), and preterm delivery (84.9 pg/mL; P = .007). When PP13 was expressed as multiples of the gestational age-specific medians among the control subjects, the multiples of the medians were 0.2 for preeclampsia, 0.6 for IUGR, and 0.6 for preterm delivery (P < .001 for each disorder compared with control subjects). Receiver operating characteristic analysis yielded areas under the curve of 0.91, 0.65, and 0.60 for preeclampsia, IUGR, and preterm delivery, respectively. At a 90% specificity rate, the corresponding sensitivities were 79%, 33%, and 28%, respectively.
Conclusion:
The screening of maternal PP13 levels in the first trimester is a promising diagnostic tool for the prediction of preeclampsia with high sensitivity and specificity.
