Photo Credit: Aleksandra Chalova
Elevations in biomarkers such as uterine artery pulsatility index and placental growth factor throughout pregnancy indicate preeclampsia risk.
High-risk women who developed preeclampsia routinely experienced elevations in biomarkers throughout pregnancy indicative of preeclampsia risk, according to findings published in the American Journal of Obstetrics & Gynecology.
“There is limited evidence in the literature regarding the temporal changes of preeclampsia-related biomarkers during pregnancy in high-risk women who develop preeclampsia despite the administration of aspirin prophylaxis,” researchers wrote. “This study aimed to compare the temporal changes in mean arterial pressure, uterine artery pulsatility index, placental growth factor, and soluble fms-like tyrosine kinase-1 across gestation in women identified as having high risk for preterm preeclampsia receiving aspirin prophylaxis and low-risk women without aspirin treatment.”
The study team conducted a prospective longitudinal investigation of 2,007 women with singleton pregnancies at a single center between January 2020 and May 2023. Maternal factors using mean arterial pressure, uterine artery pulsatility index, and placental growth factor established risk for developing preterm preeclampsia. High-risk women (adjusted risk, ≥1:100) received aspirin daily at either 100 or 160 mg according to maternal weight, starting before 16 weeks until 36 weeks or until delivery or the onset of preeclampsia prior to 36 weeks. Low-risk women were matched according to maternal age, weight, and scan date. Patients were followed at 12 to 15+6, 20 to 24+6, and 30 to 37+6 weeks.
Arterial Pressure, Placental Growth Factor & Other Findings
The study included 403 low-risk women without preeclampsia, 1,471 high-risk women without preeclampsia, and 133 high-risk women who developed preeclampsia.
The low-risk group had significantly lower estimated marginal mean log10 mean arterial pressure multiple of the median, log10 uterine artery pulsatility index multiple of the median, log10 soluble fms-like tyrosine kinase-1 multiple of the median, and higher estimated marginal mean log10 placental growth factor multiple of the median across gestations versus the high-risk groups (P<0.001).
Among high-risk women, those who developed preeclampsia had a significantly higher estimated marginal mean log10 mean arterial pressure multiple of the median (0.06378 vs 0.02985; P<0.001), log10 uterine artery pulsatility index multiple of the median (0.08651 vs 0.02226; P<0.001), log10 soluble fms-like tyrosine kinase-1 multiple of the median (0.13204 vs 0.01234; P<0.001), and lower estimated marginal mean log10 placental growth factor multiple of the median (−0.33504 vs −0.16388; P<0.001) across gestation versus those without preeclampsia.
An individual gestational time point analysis showed that, compared with high-risk women without preeclampsia, those who developed preeclampsia experienced greater log10 mean arterial pressure multiple of the median in all three trimesters, higher log10 uterine artery pulsatility index multiple of the median and lower log10 placental growth factor multiple of the median in the second and third trimesters, and greater log10 soluble fms-like tyrosine kinase-1 multiple of the median in the third trimester.
Using Biomarkers in Risk Stratification
The findings indicate that, compared with those who did not develop preeclampsia, high-risk women who went on to develop preeclampsia consistently experienced:
- High mean arterial pressure levels during the first trimester that remained unchanged during pregnancy;
- High uterine artery pulsatility index levels and low placental growth factor levels starting in the second trimester; and
- High soluble fms-like tyrosine kinase-1 levels in the third trimester.
All observed findings occurred despite the use of low-dose aspirin, study investigators noted.
“These findings underscore the role of these biomarkers in further risk stratification for the development of preeclampsia among high-risk women following aspirin administration,” they wrote.
