The title above is from the National Institute of Child Health and Human Development (NICHD) report. Anyone in medicine knows that finding markers of impending preeclampsia is a holy grail of obstetrics. We report, you decide on the significance of this:
High levels of two proteins in the blood of pregnant women appear to indicate the subsequent development of preeclampsia, a life-threatening complication of pregnancy, report a team of researchers from the National Institutes of Health and Beth Israel Deaconess Medical Center. The proteins, which interfere with the growth and function of blood vessels, also signal the development of high blood pressure during pregnancy.
The findings appear in the September 7 New England Journal of Medicine…
Abnormally high levels of these proteins appear to deprive the blood vessels of substances needed to keep the lining of the blood vessels healthy. Deprived of these essential substances, the cells lining the blood vessels begin to sicken and die. As a result, the blood pressure increases, and the blood vessels leach protein into the tissues and urine.
The first of these two proteins is known as soluble endoglin. It begins accumulating in the blood of pregnant women 2 to 3 months before they develop preeclampsia. In women who developed preterm preeclampsia, levels of soluble endoglin began to rise in the 17th to the 20th week of pregnancy. In women who developed preeclampsia at full term, soluble endoglin levels rose at the 25th to the 28th week of pregnancy.
Similarly, soluble endoglin levels also rose in the 33rd through the 36th week of pregnancy for women who later developed gestational hypertension-hypertension without protein in the urine. Levels rose still further after the onset of gestational hypertension.
“This finding suggests that gestational hypertension is a mild form of preeclampsia,” said Dr. Levine.
The second protein involved in the chemical imbalance is called soluble fms-like tyrosine kinase 1 (sFlt1). The women in the study who had developed preeclampsia had increased levels of sFlt1. The increase in sFlt1 was accompanied by reduced levels of a substance, placental growth factor (PlGF). Both women with term preeclampsia and women with gestational hypertension had a simultaneous rise in soluble endoglin, and an increase in the ratio of sFlt1 to PlGF (high levels of sFlt1 and low levels of PlGF.)
“Both soluble endoglin and the altered sFlt1/PlGF ratio appear to contribute to the development of preeclampsia, Dr. Levine said. “Severe disease usually occurs in women with high levels of both measures and not in women with high levels of only one or the other.”
Dr. Levine added that detecting high levels of both soluble endoglin and sFlt1 early in pregnancy might be especially helpful in predicting the later development of preeclampsia.