ROLE OF FIRST-TRIMESTER BIOMARKERS IN PREDICTING PREECLAMPSIA
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Keywords
Preeclampsia, First-trimester biomarkers, Pregnancy-associated plasma protein-A; Placental growth factor, Placental protein-13, Soluble fms-like tyrosine kinase-1, Soluble endoglin, Early prediction
Abstract
Background: Preeclampsia is among the leading causes of maternal and perinatal morbidity and mortality across the world. The pathological processes leading to the disease begin during early pregnancy, thus identification of effective first-trimester biomarkers may aid in its early prediction and timely preventive management. This study was conducted with the aim of evaluating the role of first-trimester biomarkers in predicting preeclampsia.
Materials and Methods: This prospective observational study was conducted in the Department of Obstetrics and Gynaecology, Sardar Patel Institute of Medical Sciences and Research, Lucknow. The study was conducted over a period of 14 months from March 2025 to April 2026. Two hundred thirty-five singleton pregnant women attending antenatal clinics at 11+0 to 13+6 weeks of gestation were recruited and followed up till delivery. Maternal demographic and clinical characteristics were noted. Serum levels of pregnancy-associated plasma protein-A (PAPP-A), placental growth factor (PlGF), placental protein-13 (PP13), soluble fms-like tyrosine kinase-1 (sFlt-1) and soluble endoglin (sEng) were assessed during first trimester and their association with preeclampsia and diagnostic performance for prediction of preeclampsia were analysed.
Results: Women who later developed preeclampsia had significantly lower levels of PAPP-A (0.68 ± 0.22 vs. 1.14 ± 0.39 MoM), PlGF (28.5 ± 9.8 vs. 45.7 ± 12.6 pg/mL) and PP13 (54.3 ± 13.7 vs. 71.8 ± 15.4 pg/mL), whereas sFlt-1 (16 85 ± 295 vs. 12 45 ± 238 pg/mL) and sEng (7.8 ± 1.6 vs. 5.9 ± 1.2 ng/mL) were significantly higher (p < 0.001) in first trimester. PlGF showed strongest association with preeclampsia (OR = 5.36; 95% CI: 2.42–11.84). The model with combination of all biomarkers yielded the best diagnostic performance with 90.6% sensitivity, 91.6% specificity, 91.5% diagnostic accuracy and Area Under Curve (AUC) of 0.95.
Conclusion: First-trimester biomarkers predict preeclampsia effectively. Decreased levels of PAPP-A, PlGF and PP13 with concomitant increase in sFlt-1 and sEng were significantly associated with subsequent development of preeclampsia. Combined biomarker model showed the best predictive performance and can potentially help in early risk stratification allowing timely preventive measures leading to better maternal and perinatal outcome.
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