Clinical and biochemical markers for the prediction and early diagnosis of pregnancy related complications
Date
2023-10-25
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Abstract
Kuigi enamus rasedustest kulgeb probleemideta, kogeb iga neljas naine raseduse ajal tüsistusi.
Aastatel 2012 - 2018 uurisime preeklampsia (PE) ja gestatsioondiabeedi (GDM) riskitegurite esinemissagedust ning sõeltestide efektiivsust Tartu Ülikooli Kliinikumi naistekliinikus jälgimisel olnud rasedate hulgas.
PE on rasedustüsistus, millele viitab vererõhu tõus raseduse teises pooles ning lisanduvad muude organite kahjustuse sümptomid. Vähemalt üks PE riskile viitav riskitegur (PE varasema raseduse ajal, krooniline hüpertensioon, diabeet, kunstlik viljastamine, mitmikrasedus, esimene oodatav sünnitus, rasvumine ja ema vanus > 40 a) esines 53%-l uuritud rasedatest. Riskiteguri olemasolu suurendas PE tekke riski 7,8 korda. Suurem tõenäosus PE tekkimiseks oli rasedatel, kellel oli diabeet või PE eelneva raseduse ajal. Enamusel riskiteguritega rasedatest PE ei teki.
Raseduse III trimestri PE riski hindamiseks analüüsisime kahe platsentast pärineva biomarkeri (sFlt-1 ja PlGF) taset III trimestril kogutud vereproovidest. Test tuvastas 58% naistest, kellel hiljem diagnoositi PE, valepositiivseid tulemusi oli 10%.
PE juhtude varast avastamist on võimalik parandada uudse multimarker testi abil. Kombineerides biomarkereid (sFlt-1, PlGF, ADAM12, sENG ja leptin) ning kliinilist infot (raseduse kestus ja ema kaal verevõtul) on võimalik tuvastada 100% rasedatest, kelle hiljem diagnoositakse PE. Antud testil oli valepositiivseid juhte 4%.
GDM on üks sagedaseimaid rasedustüsistusi, mis diagnoositakse, kui raseduse ajal teostatud glükoosi tolerantsus testil (GTT) on veresuhkru väärtus normist kõrgem.
Eestis suunatakse GTT-le rasedad, kellel on varasem GDM või suurekaaluline vastsündinu, diabeet lähisugulasel, polütsüstiliste munasarjade sündroom, paastusuhkur >5,1 mmol/L, glükosuuria, ülekaalulisus, liigne rasedusaegne kaaluiive või kahtlus suurele lootele.
Uuringus leiti, et seitsme aasta jooksul on suurenenud GDM riskiteguritega naiste arv, rohkem rasedaid suunatakse GTT-le ning samuti on tõusnud GDM esinemissagedus.
Rasedad, kellel on GDM riskitegurid, isegi kui GTT on normis, on ohustatud suuremast rasedusaegsest kaaluiibest ja sünnitavad suurema sünnikaaluga lapse.
Most of the pregnancies proceed without problems, however, complications occur approximately one in four pregnancies. Between 2012 to 2018 we conducted three studies in Women’s Clinic, Tartu University Hospital to assess risk factors and screening methods for preeclampsia (PE) and gestational diabetes (GDM). PE is pregnancy complication with new hypertension after 20 pregnancy weeks and additional maternal or fetal health problems. At least one of the risk factors referring to increased risk for PE (chronic hypertension, diabetes, kidney disease, previous PE, obesity, IVF, maternal age > 40 and nulliparity) occurred in 53% of pregnant population. Presence of a risk factor increased individuals’ risk for PE 7.8-fold, especially for women with pre-pregnancy diabetes and/or previous PE. However most women with risk factors will not develop PE. For early PE detection in the III trimester, two placenta derived markers (sFlt-1 and PlGF), were analyzed from blood samples of pregnant women. The test detected 58% of subsequent PE cases with false positive rate of 10%. The detection was improved by combining simultaneous measurement of biomarkers (sFlt-1, PlGF, ADAM12, sENG, and leptin) and maternal characteristics (gestational age and maternal weight at the blood draw). This novel test detected 100% of subsequent PE cases with 4% of false positive rate. GDM, is one of the most common pregnancy complications and is diagnosed when hyperglycemia is detected during oral glycose tolerance test (OGTT) after 20 pregnancy weeks. In Estonia, referral to OGTT for GDM screening is recommended for women with risk-factors: overweight or obesity, family history of diabetes, previous GDM and/or birth of a large newborn, polycystic ovaries syndrome, fasting glucose >5.1 mmol/L, glycosuria, excessive weight gain or suspicion of macrosomic fetus. Our study showed increasing numbers of individuals with GDM risk factors, referrals to OGTT and GDM diagnosis within seven years. Pregnant women with GDM risk factors, despite of normal OGTT, were at risk of increased gestational weight gain and large for gestational age newborns.
Most of the pregnancies proceed without problems, however, complications occur approximately one in four pregnancies. Between 2012 to 2018 we conducted three studies in Women’s Clinic, Tartu University Hospital to assess risk factors and screening methods for preeclampsia (PE) and gestational diabetes (GDM). PE is pregnancy complication with new hypertension after 20 pregnancy weeks and additional maternal or fetal health problems. At least one of the risk factors referring to increased risk for PE (chronic hypertension, diabetes, kidney disease, previous PE, obesity, IVF, maternal age > 40 and nulliparity) occurred in 53% of pregnant population. Presence of a risk factor increased individuals’ risk for PE 7.8-fold, especially for women with pre-pregnancy diabetes and/or previous PE. However most women with risk factors will not develop PE. For early PE detection in the III trimester, two placenta derived markers (sFlt-1 and PlGF), were analyzed from blood samples of pregnant women. The test detected 58% of subsequent PE cases with false positive rate of 10%. The detection was improved by combining simultaneous measurement of biomarkers (sFlt-1, PlGF, ADAM12, sENG, and leptin) and maternal characteristics (gestational age and maternal weight at the blood draw). This novel test detected 100% of subsequent PE cases with 4% of false positive rate. GDM, is one of the most common pregnancy complications and is diagnosed when hyperglycemia is detected during oral glycose tolerance test (OGTT) after 20 pregnancy weeks. In Estonia, referral to OGTT for GDM screening is recommended for women with risk-factors: overweight or obesity, family history of diabetes, previous GDM and/or birth of a large newborn, polycystic ovaries syndrome, fasting glucose >5.1 mmol/L, glycosuria, excessive weight gain or suspicion of macrosomic fetus. Our study showed increasing numbers of individuals with GDM risk factors, referrals to OGTT and GDM diagnosis within seven years. Pregnant women with GDM risk factors, despite of normal OGTT, were at risk of increased gestational weight gain and large for gestational age newborns.
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Keywords
pregnancy complications, preeclampsia, diabetes, biochemical markers, health risks