PAPP-A2 and Inhibin A as Novel Predictors for Pregnancy Complications in Women With Suspected or Confirmed Preeclampsia.

Abstract

Background We aimed to evaluate the value of inhibin A and PAPP-A2 (pregnancy-associated plasma protein-A2) as novel biomarkers in the prediction of preeclampsia-related complications and how they compare with angiogenic biomarkers. Methods and Results Making use of a secondary analysis of a prospective, multicenter, observational study, intended to evaluate the usefulness of sFlt-1 (soluble Fms-like tyrosine kinase-1)/PlGF (placental growth factor) ratio, we measured inhibin A and PAPP-A2 levels in 524 women with suspected/confirmed preeclampsia. Women had a median gestational age of 35 weeks (range, 20-41 weeks) while preeclampsia occurred in 170 (32%) women. Levels of inhibin A and PAPP-A2 were significantly increased in women with preeclampsia and in maternal perfusate of preeclamptic placentas. Inhibin A and PAPP-A2 (C-index = 0.73 and 0.75) significantly improved the prediction of maternal complications when added on top of the traditional criteria; gestational age, parity, proteinuria, and diastolic blood pressure (C-index = 0.60). PAPP-A2 was able to improve the C-index from 0.75 to 0.77 when added on top of the sFlt-1/PlGF ratio for the prediction of maternal complications. To discriminate fetal/neonatal complications on top of traditional criteria, inhibin A and PAPP-A2 showed additive value (C-index = 0.79 to 0.80 and 0.82, respectively) but their discriminative ability remained inferior to that of sFlt-1/PlGF ratio or PlGF. Interestingly, the PAPP-A2/PlGF ratio alone showed remarkable value to predict pregnancy complications, being superior to sFlt-1/PlGF ratio in the case of maternal complications. Conclusions Inhibin A and PAPP-A2 show significant potential to predict preeclampsia-related pregnancy complications and might prove beneficial on top of the angiogenic markers.

• Authors: Rugina I Neuman, Maaike M Alblas van der Meer, Daan Nieboer, Langeza Saleh, Koen Verdonk, Bhanu Kalra, Ajay Kumar, Kannan Alpadi, Anton H van den Meiracker, Willy Visser, A H Jan Danser
• Journal: Journal of the American Heart Association (J Am Heart Assoc) Vol. 9 Issue 19 Pg. e018219 (10 20 2020) ISSN: 2047-9980 [Electronic] England
• PMID: 32990126 (Publication Type: Journal Article, Multicenter Study, Observational Study)

Chemical References

• Biomarkers
• inhibin A
• Inhibins
• PAPPA2 protein, human
• Pregnancy-Associated Plasma Protein-A

Topics

• Adult
• Biomarkers (blood)
• Female
• Gestational Age
• Humans
• Inhibins (blood)
• Pre-Eclampsia (blood, diagnosis)
• Predictive Value of Tests
• Pregnancy
• Pregnancy-Associated Plasma Protein-A (analysis)
• Prospective Studies