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Third-Trimester NT-proBNP for Pre-eclampsia Risk Prediction: A Comparison With sFlt-1/PlGF in a Population-Based

Lucas Bacmeister1, Annette Buellesbach1, Dorte Glintborg2

  • 1Clinic for Cardiology and Angiology, University Heart Center Freiburg - Bad Krozingen, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.

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|March 20, 2025
PubMed
Summary

Third-trimester N-terminal pro B-type natriuretic peptide (NT-proBNP) levels show limited value in predicting pre-eclampsia risk. This biomarker does not improve prediction accuracy when combined with angiogenic biomarkers like sFlt-1/PlGF.

Keywords:
cardio-obstetricshypertensionnatriruretic peptidespre-eclampsiarisk prediction

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Area of Science:

  • Obstetrics and Gynecology
  • Cardiovascular Biomarkers
  • Pregnancy Complications

Background:

  • The role of N-terminal pro B-type natriuretic peptide (NT-proBNP) in early pre-eclampsia risk is unclear, despite elevated levels at diagnosis.
  • This contrasts with findings of lower first-trimester NT-proBNP associated with increased pre-eclampsia risk.

Purpose of the Study:

  • To evaluate the effectiveness of third-trimester NT-proBNP measurements for predicting pre-eclampsia onset.
  • To compare the predictive utility of NT-proBNP with established angiogenic biomarkers.

Main Methods:

  • NT-proBNP and soluble Fms-like tyrosine kinase 1/placental growth factor (sFlt-1/PlGF) ratio were measured in 1,476 pregnant individuals at 29 weeks gestation.
  • Pre-eclampsia cases were classified based on onset timing: within 4 weeks or more than 4 weeks post-sampling.

Main Results:

  • Higher NT-proBNP levels correlated with increased short-term (within 4 weeks) pre-eclampsia risk (OR 2.18, P=0.09).
  • Conversely, higher NT-proBNP levels were associated with reduced long-term (beyond 4 weeks) risk (OR 0.72, P=0.012).
  • Combining NT-proBNP with sFlt-1/PlGF did not enhance predictive accuracy for either short- or long-term pre-eclampsia risk.

Conclusions:

  • Early third-trimester NT-proBNP screening offers limited clinical utility for predicting pre-eclampsia.
  • Angiogenic biomarkers like sFlt-1/PlGF demonstrate superior predictive value compared to NT-proBNP alone.