9: First trimester multi-analyte screening for placental development


      To examine 1st trimester relationships between maternal characteristics, placental Doppler studies and serum markers of placental angiogenesis (Angiopoietin-2, ANG-2, Placental growth factor, PIGF), placental mass (pregnancy associated protein-A, PAPP-A, placental protein-13, PP-13, free beta HCG) and inflammation (Pentraxin-3, PTX-3).

      Study Design

      Prospectively enrolled patients at 11-14 weeks had serum ANG-2, PIGF, PAPP-A, PP-13 and PTX measured by ELISA. Levels of markers were correlated to each other and related to gestational age (GA), maternal age, race, body mass index (BMI), mean arterial blood pressure (MAP), nicotine/caffeine use as well as measures of uterine and umbilical artery blood flow resistance.


      111 consecutive patients completed the multi-analyte screen. ANG-2 correlated with PIGF and pp-13 (Pearson 0.484, 0,326). PP-13 correlated with free betaHCG (Pearson 0.386, all p<0.0001). ANG-2 and pp-13 were the only factors related to BMI, while ANG-2 showed the stronger relationships MAP than PIGF. Smoking had a significant impact on PP-13 levels and only PIGF was related to placental Doppler studies (table stars indicate significant relationships *=p<0.05, **=p<0.001). PTX-3 had no significant relationships with any study parameter.
      Tabled 1Analyte relationships
      Age / race−/−−/−−/−−/−
      Uterine Doppler*
      Umbilical Doppler*


      Of the maternal serum analytes that reflect placental angiogenesis ANG-2 relates most to maternal vascular risk factors while PIGF levels show closer relationship with placental blood flow resistance. PP-13 acts as a marker of placental mass illustrating the effects of smoking in the first trimester. These independent relationships suggest a potential benefit of a multi-analyte screening algorithm for placental development in the first trimester.