Please cite this paper as: Wortelboer E, Koster M, Cuckle H, Stoutenbeek P, Schielen P, Visser G. First‐trimester placental protein 13 and placental growth factor: markers for identification of women destined to develop early‐onset pre‐eclampsia. BJOG 2010;117:1384–1389.
Objective To investigate the predictive value of maternal serum pregnancy‐associated plasma protein A (PAPP‐A), free β subunit of human chorionic gonadotrophin (fβ‐hCG), placental protein 13 (PP13), placental growth factor (PlGF) and a desintegrin and metalloproteinase 12 (ADAM12), for first‐trimester identification of early‐onset pre‐eclampsia.
Design Nested case–control study.
Setting Routine first‐trimester screening for trisomy 21 in the Netherlands.
Population Eighty‐eight women who developed pre‐eclampsia or haemolysis, elevated liver enzymes, low platelets (HELLP) syndrome before 34 weeks of gestation and 480 controls.
Methods PP13, PlGF and ADAM12 were measured in stored first‐trimester serum, previously tested for PAPP‐A and fβ‐hCG. All marker levels were expressed in multiples of the gestation‐specific normal median (MoMs). Model predicted detection rates for fixed false‐positive rates were obtained for statistically significant markers alone and in combination.
Main outcome measures Development of pre‐eclampsia or HELLP syndrome.
Results PP13 and PlGF were reduced in women with pre‐eclampsia, with medians 0.68 MoM and 0.73 MoM respectively (P < 0.0001 for both). PAPP‐A was reduced (median 0.82 MoM, P < 0.02) whereas ADAM12 and fβ‐hCG did not differ between control women and those with pre‐eclampsia. In pre‐eclampsia complicated by a small‐for‐gestational‐age fetus, all markers except fβ‐hCG had lower values, compared with pregnancies involving fetuses of normal weight. The model‐predicted pre‐eclampsia detection rate for a combination of PP13 and PlGF was 44% and 54%, respectively, for a fixed 5% and 10% false‐positive rate.
Conclusion This study demonstrates that PP13 and PlGF in the first‐trimester might be promising markers in risk assessment for early pre‐eclampsia/HELLP syndrome but for an adequate screening test additional characteristics are necessary.