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ORIGINAL PAPER
Abstract
Preeclampsia (PE) remains one of the leading causes of maternal, fetal and neonatal mortality and morbidity
worldwide. Early identification of a subgroup of patients with an increased risk for PE became one of the most
important goals in perinatal medicine. Our objective was to examine the possible relationship of PLGF measurements in late 1st trimester of pregnancy with selected maternal clinical features, maternal serum concentrations
of pregnancy-associated plasma protein-A (PAPP-A), free $-human chorionic gonadotropin ($-hCG) and various
late pregnancy complications. The studied group included 113 pregnant women with singleton pregnancies between 11 weeks+0 days and 13 weeks +6 days of gestation. Mean age of these women was 38.8 years (range: 16
to 42 years). Mean neonatal weight at delivery was 3367 g (median 3460 g, min-max 150-5660 g). Median maternal serum PLGF concentration was 32.38 pg/ml (interquartile range: 23.6-46.6 pg/ml, SD = 51.18 pg/mol, minmax = 10.1-593.5 pg/ml). Median concentrations of PLGF decreased with the increase of gestational age. Normal
vaginal delivery occurred in 52 women in the studied group and there were 61 cesarean sections performed for
various indications. Mean body mass index (BMI) value of studied pregnant women was 24.3 4.1 (min-max: 18.438.2). Fetal crown-rump length (CRL) ranged from 45 mm to 83mm and measured nuchal translucency (NT)
values ranged from 1.01 to 3.1 mm (median 1.91 mm). Multiple of the Medians (MoMs) of free beta HCG and
PAPP-A were 0.73 (range: 0.51-1.07) and 3.08 (range: 1.81-4.94), respectively. A significant correlation between
maternal serum PLGF concentrations and fetal CRL in the late 1st trimester of gestation was found R = 0.19;
p = 0.04). No statistically significant correlations were found between maternal serum PLGF levels and other studied parameters such as: maternal BMI, fetal NT, and calculated MoMs of free beta HCG as well as PAPP-A in
maternal serum (all ps > 0.005). We conclude that serum placental growth factor measurements in the late 1st
trimester may provide additional prognostic value in predicting various late pregnancy complications including
preeclampsia.
Key words: early pregnancy, placental growth factor (PLGF), PAPP-A, preeclampsia screening
ternal spiral artery modification with the resulting placental ischemia are all associated with the release of several specific molecules, mostly proteins, as well as cellfree fetal DNA and RNA [13, 16, 17]. These molecules
can now be detected in the maternal blood, and changes
in their concentrations can be further used for early
identification and prediction of preeclampsia, long before
to the appearance of the typical clinical symptoms of
hypertension with proteinuria [16, 17].
Currently, for women between 11th and 14th week of
gestation several biophysical and biochemical markers
have been proposed, most frequently in a combinatory
analysis [14]. Some of early predictors or diagnostic
tools of preeclampsia include measurements of pregnancy associated protein A (PAPP-A), placental growth
200
Placental growth factor (PLGF) with PAPP-A and free beta hCG assessment
201
SD
MD
47,9
57.1
44.1
39,9
32.9
31.8
Range
(Min-max.)
15.9-139
10.9-593
10.1-253
Interquartile range
P value
25.9-48.3
24.3-56.4
21-40
H = 1.53;
p = 0.46
Table 2. Selected clinical, sonographic and biochemical parameters with birth weight characteristics and pregnancy
complications compared to PLGF levels in late 1st trimester of gestation
Neonatal birth weight
Statistical
(median and range)
analysis
3456 g (2010 g-5660 g)
No complications N = 90
Z = 0.9;
p = 0.33
3350 g (2700 g-3790 g)
Complications N = 23
Type of delivery
Normal vaginal delivery N = 52
3600 g (3200 g-3850 g)
Z = !2.68;
p = 0.007
3360 g (2800 g-3620 g)
Cesarean section N = 61
Hypertensive disorders of pregnancy
No hypertension N = 107
3450 g (3100 g-3705 g)
Z = !1.28;
p = 0.19
3715 g (3360 g-4050 g)
Hypertensive disorders in late gestation N =6
Number
Time of delivery
3480 g (3180 g-3800 g)
2600 g (2420 g-3170 g)
Z =3 .6;
p = 0.0003
PLGF pg/ml
(median, range)
34.9 (24.3-48.7)
25.5 (22.3-34.2)
Statistical
analysis
33.9 (24.6-48.7)
32.2 (22.3-46.2)
Z =!0.68;
p = 0.49
33.3 (23.6-47.6)
30.1 (23.8-36.4)
Z = 0.5;
p = 0.5
33.4 (23.8-47.6)
27.6 (18.2-46.6)
Z = 0.5;
p = 0.5
Z = 1.95;
p = 0.05
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Placental growth factor (PLGF) with PAPP-A and free beta hCG assessment
mester maternal serum free beta human chorionic gonadotrophin and pregnancy associated plasma protein A
as predictors of pregnancy complications. BJOG 2000;
107: 1265-1270.
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23-3.
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203
Artur Czekierdowski
Ist Department of Gynecological Oncology
and Gynecology
Medical University in Lublin
20-081 Lublin, Staszica 16
e-mail: arc30@wp.pl