To investigate the value of first trimester maternal serum measurements of A Disintegrin And Metalloprotease 12-S (ADAM12s) and Placental Protein 13 (PP13) in the prediction of preeclampsia (PE), pregnancy induced hypertension (PIH) and intra-uterine growth restriction (IUGR).
A retrospective case-control study of samples taken between 2004 – 2007 was conducted. Gestational age ranged from 9+0 to 13+6 weeks. All samples were collected as part of the national program for Down Syndrome Screening. All PE, PIH and IUGR cases were matched for exact gestational age and maternal age with three control cases. The serum concentration of ADAM12s and PP13 were analyzed ‘blind′ to outcome. Results were expressed in multiples of the median (MoM). MoM values were compared using Mann-Whitney U test and receiver-operator-characteristics (ROC) curves were used to asses screening performance.
165 controls samples, 17 cases of PE, 30 cases of PIH and 8 cases of IUGR were identified. Median ADAM12s concentrations for controls versus cases were significantly reduced: 405 vs. 324 nG/L (MoM 1.00 vs. 0.80 (p < 0.05)). In PP13 no significant difference was found: 57.7 vs. 54.6 pG/L (MoM 1.00 and 0.95). Median MoM levels for ADAM12s were 0.90, 0.77 and 0.88 for PE, PIH and IUGR respectively; MoM levels for PP13 were 0.77, 0.95 and 0.89 respectively. ROC analysis yielded areas under the curve (AUC) for ADAM12s and PP13 of 0.63 and 0.59 for PE, 0.68 and 0.57 for PIH and 0.59 and 0.62 for IUGR, respectively. Combined ADAM12 and PP13 did not improve AUC. If specificity was set at 0.80, the corresponding sensitivity of ADAM12s was 52% for PIH.
Decreased first trimester levels of ADAM12s may be useful in early prediction of PIH. Decreased levels of PP13 were not significantly correlated with adverse pregnancy outcome. Combining ADAM12s and PP13 does not appear to improve screening performance.
© 2009 Mosby, Inc. Published by Elsevier Inc. All rights reserved.