Maternal plasma soluble neuropilin-1 is downregulated in fetal growth restriction complicated by abnormal umbilical artery Doppler: a pilot study

New first trimester circulating angiogenic biomarkers in predicting early-onset and late-onset fetal growth restriction: a case-control study

BACKGROUND

First trimester prediction of fetal growth restriction (FGR) remain suboptimal. We aimed to search for new circulating angiogenic biomarkers for improvement.

METHODS

This case-control study compared 73 singleton pregnancies with early or late-onset FGR based on Delphi consensus and 73 matched normal controls. Their maternal serum samples stored during 11-13 weeks were retrieved for measurement of 36 angiogenic biomarkers by MILLIPLEX® human angiogenesis magnetic bead panels. Those biomarkers that showed significant differences between the study groups were further analysed with receiver operating characteristic (ROC) curve.

RESULTS

In the early-onset FGR group, log10MoM of soluble neuropilin-1 (sNRP-1: 0.08 ± 0.11 vs. 0.00 ± 0.09, P < 0.001) and log10MoM of soluble platelet and endothelial cell adhesion molecule 1 (sPECAM-1: 0.05 ± 0.06 vs. 0.00 ± 0.09, P < 0.05) were significantly higher than the control group, while log10MoM of platelet-derived growth factor AB/BB (PDGF-AB/BB: -0.08 ± 0.13 vs. 0.00 ± 0.16, P < 0.05) and PAPP-A (-0.15 ± 0.28 vs. 0.05 ± 0.23, P < 0.001) were lower. Their combination achieved the highest area under the ROC curve (AUC) of 0.83 (95% CI: 0.74-0.95) with a higher sensitivity than that of PAPP-A alone (61.5% vs. 30.8% at 10% false positive rate, P < 0.001). Concerning the late-onset FGR group, only log10MoMs of sFlt-1 (-0.12 vs. 0.00, P < 0.001) and PAPP-A (-0.07 vs. 0.05, P < 0.05) were lower than the control group, but their AUC was only 0.68 (95% CI:0.59-0.78).

CONCLUSIONS

Three new first trimester biomarkers, sNRP-1, sPECAM-1 and PDGF-AB/BB are predictive of subsequent development of early-onset FGR.

Maternal serum fatty acid binding protein-4 level is upregulated in fetal growth restriction with abnormal Doppler flow patterns

PURPOSE

This study aimed to determine fatty acid binding protein-4 (FABP-4) concentrations in maternal serum of fetal growth restriction (FGR) pregnancies and controls of normal pregnancies. Furthermore, we hypothesized that the alterations in FABP-4 levels might correlate with FGR severity.

METHODS

We performed this prospective case-control study with 83 pregnant women. The study groups included 26 FGR pregnancies without abnormal fetal Doppler flow patterns and 25 pregnancies complicated with FGR accompanied by abnormal fetal Doppler flow patterns.

RESULTS

The median serum FABP-4 concentrations were significantly higher in the FGR cases with abnormal Doppler flow pattern group (2.09 ng/mL) than in the FGR cases without abnormal Doppler flow pattern group (1.62 ng/mL) and the control group (1.20 ng/mL, p < 0.001). A significant negative correlation was observed between maternal serum FABP-4 levels and time to birth from blood sample collection (r = -0.356 and p = 0.001), gestational week at birth (r = -0.386 and p < 0.001), and birth weight (r = -0.394 and p < 0.001). A 1.35 ng/mL cut-off value of serum FABP-4 level could be used to discriminate FGR cases with a 78.4% sensitivity and 60.6% specificity. The optimal cut-off value of FABP-4 levels as an indicator for the diagnosis of FGR with abnormal Doppler flow pattern was estimated to be 1.76 ng/mL, which yielded a sensitivity of 84.0% and a specificity of 75.8%.

CONCLUSION

FABP-4 is a crucial biomarker in the diagnosis and determining the severity of pregnancies with restricted fetal growth. We consider that FABP-4 is a powerful, reliable, and unique biomarker to diagnose FGR pregnancies.