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Second- and third-trimester serum levels of growth-differentiation factor-15 in prediction of pre-eclampsia
D Wertaschnigg1,2, D L Rolnik1, G Nie3,4
1Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.
Insights
Serum growth-differentiation factor-15 (GDF-15) is not a reliable predictor for pre-eclampsia (PE) in early or late pregnancy. Elevated GDF-15 levels at 30-34 weeks gestation may indicate preterm PE, but are unlikely useful alone.
Area of Science:
- Reproductive Medicine
- Maternal-Fetal Medicine
- Biomarker Discovery
Background:
- Pre-eclampsia (PE) poses significant risks to maternal and perinatal health.
- Accurate prediction and early diagnosis of PE remain a clinical challenge.
- Growth-differentiation factor-15 (GDF-15) is a potential biomarker for pregnancy complications.
Purpose of the Study:
- To compare serum GDF-15 levels at different gestational ages in women who developed preterm or term PE versus healthy controls.
- To assess the predictive value of GDF-15 for pre-eclampsia development.
Main Methods:
- A case-control study involving 300 women from a prospective observational study.
- Serum GDF-15 levels measured via ELISA at 19-24, 30-34, and 35-37 weeks gestation.
- Statistical analysis using multiple linear regression and comparison of GDF-15 multiples of the median (MoM) adjusted for covariates.
Main Results:
- GDF-15 levels increased with gestational age.
- No significant differences in GDF-15 MoM were observed at 19-24 or 35-37 weeks gestation between PE cases and controls.
- Significantly increased GDF-15 MoM values were found at 30-34 weeks gestation in women who subsequently developed preterm PE, but not term PE. Elevated GDF-15 MoM at 30-34 weeks correlated with a shorter interval to PE delivery.
Conclusions:
- Serum GDF-15 levels at 19-24 or 35-37 weeks gestation do not predict preterm or term PE.
- While GDF-15 levels are higher in women who later develop preterm PE at 30-34 weeks, the difference is small.
- GDF-15, when used in isolation, is unlikely to be clinically useful for pre-eclampsia prediction.
Objective:
Pre-eclampsia (PE) is a significant contributor to adverse maternal and perinatal outcome; however, accurate prediction and early diagnosis of this condition remain a challenge. The aim of this study was to compare serum levels of growth-differentiation factor-15 (GDF-15) at three different gestational ages between asymptomatic women who subsequently developed preterm or term PE and healthy controls.
Methods:
This was a case-control study drawn from a prospective observational study on adverse pregnancy outcomes in women attending for their routine second- and third-trimester hospital visits. Serum GDF-15 was determined in 300 samples using a commercial GDF-15 enzyme-linked immunosorbent assay: 120 samples at 19-24 weeks of gestation, 120 samples at 30-34 weeks and 60 samples at 35-37 weeks. Multiple linear regression was applied to logarithmically transformed GDF-15 control values to evaluate the influence of gestational age at blood sampling and maternal characteristics on GDF-15 results. GDF-15 multiples of the normal median (MoM) values, adjusted for gestational age and maternal characteristics, were compared between pregnancies that subsequently developed preterm or term PE and healthy controls.
Results:
Values of GDF-15 increased with gestational age. There were no significant differences in GDF-15 MoM values between cases of preterm or term PE and normotensive pregnancies at 19-24 or 35-37 weeks of gestation. At 30-34 weeks, GDF-15 MoM values were significantly increased in cases of preterm PE, but not in those who later developed term PE. Elevated GDF-15 MoM values were associated significantly with a shorter interval between sampling at 30-34 weeks and delivery with PE (P = 0.005).
Conclusion:
Serum GDF-15 levels at 19-24 or 35-37 weeks of gestation are not predictive of preterm or term PE. At 30-34 weeks, GDF-15 levels are higher in women who subsequently develop preterm PE; however, this difference is small and GDF-15 is unlikely to be useful in clinical practice when used in isolation. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.
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