Glycosylated fibronectin positivity in the spectrum of hypertensive disorders of pregnancy in relation to the severity and adverse outcomes
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20220575Keywords:
Preeclampsia, Eclampsia, HELLP, Glycosylated fibronectin, Hypertensive disorders of pregnancyAbstract
Background: The aim of the study was to estimate the levels of glycosylated fibronectin (GlyFn) in preeclampsia (PE), and hypertensive disorders of pregnancy (HDP) and to correlate with the severity of the disease, adverse outcomes and complications. The study included 77 cases of HDP that were managed in the Institute of Obstetrics and Gynaecology, Modern Government Maternity Hospital (MGMH), Osmania Medical College, Hyderabad.
Methods: This study was a prospective non-interventional analytical investigative study. To ascertain the performance of this biomarker, GlyFn, we evaluated the LumellaTM GlyFn POC test.
Results: GlyFn positivity percentage was found to be highest in eclampsia (78.57%), next in PE with severe features 74.07%, in HELLP syndrome and gestational hypertension (HTN) (71.42%). In PE without severe features (66.66%) and in chronic HTN with PE superimposed (55.55%). Maternal complications include: abruption 5 (6.57%), thrombocytopenia 3 (3.94%), acute kidney injury (AKI) 3 (3.94%), post-partum hemorrhage (PPH) 3 (3.94%), and ascites 3 (3.94%). Perinatal outcome in 77 cases include: fetal growth restriction in 18 (23.37%) and total perinatal mortality was 14 (18.18%).
Conclusions: GlyFn positivity was found to be highest in eclampsia and the severe forms of PE. The positivity declined in the less severe disease. The birth weight in the severe forms of PE group was significantly lower (p<0.0006). The differences in the birth weight among the GlyFn positive and normal groups was not significant for this population size (p=0.38).
Metrics
References
Hladunewich M, Karumanchi SA, Lafayette R. Pathophysiology of the clinical manifestations of preeclampsia. Clin J Am Soc Nephrol. 2007;2(3):543-9.
Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006;367(9516):1066-74.
Steegers EA, von Dadelszen P, Duvekot JJ, Pijnenborg R. Pre-eclampsia. Lancet. 2010;376(9741):631-44.
Nobis PN, Hajong A. Eclampsia in India Through the Decades. J Obstet Gynaecol India. 2016;66(1):172-6.
Pratibha D, Reddy AM, Malati P, Bhavana K, Shobha R, Harita R. Management of Eclampsia and Imminent Eclampsia, Maternal and Perinatal Outcome in 666 Cases—2003-2007 at Government Maternity Hospital in Hyderabad. Open J Obstet Gynecol. 2017;7:193-207.
Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Am J Obstet Gynecol. 2000;183(1):1-22.
Homer CS, Brown MA, Mangos G, Davis GK. Non-proteinuric pre-eclampsia: a novel risk indicator in women with gestational hypertension. J Hypertens. 2008;26(2):295-302.
Pettit F, Brown MA. The management of pre-eclampsia: what we think we know. Eur J Obstet Gynecol Reprod Biol. 2012;160(1):6-12.
Sibai BM, Stella CL. Diagnosis and management of atypical preeclampsia-eclampsia. Am J Obstet Gynecol. 2009;200(5):481.
Magee LA, von Dadelszen P, Bohun CM, Rey E, El-Zibdeh M, Stalker S, et al. Serious perinatal complications of non-proteinuric hypertension: an international, multicentre, retrospective cohort study. J Obstet Gynaecol Can. 2003;25(5):372-82.
Levine RJ, Maynard SE, Qian C, Lim KH, England LJ, Yu KF, Schisterman EF, Thadhani R, Sachs BP, Epstein FH, Sibai BM, Sukhatme VP, Karumanchi SA. Circulating angiogenic factors and the risk of preeclampsia. N Engl J Med. 2004;350(7):672-83.
Macintire K, Tuohey L, Ye L, Palmer K, Gantier M, Tong S, Kaitu'u-Lino TJ. PAPPA2 is increased in severe early onset pre-eclampsia and upregulated with hypoxia. Reprod Fertil Dev. 2014;26(2):351-7.
Santillan MK, Santillan DA, Scroggins SM, Min JY, Sandgren JA, Pearson NA, et al. Vasopressin in preeclampsia: a novel very early human pregnancy biomarker and clinically relevant mouse model. Hypertension. 2014;64(4):852-9.
Yeung EH, Liu A, Mills JL, Zhang C, Männistö T, Lu Z, Tsai MY, Mendola P. Increased levels of copeptin before clinical diagnosis of preeclampsia. Hypertension. 2014;64(6):1362-7.
Rasanen JP, Snyder CK, Rao PV, Mihalache R, Heinonen S, Gravett MG, et al. Glycosylated fibronectin as a first-trimester biomarker for prediction of gestational diabetes. Obstet Gynecol. 2013;122(3):586-94.
Rasanen J, Girsen A, Lu X, Lapidus JA, Standley M, Reddy A, et al. Comprehensive maternal serum proteomic profiles of preclinical and clinical preeclampsia. J Proteome Res. 2010;9(8):4274-81.
Rasanen J, Quinn MJ, Laurie A, Bean E, Roberts CT, Nagalla SR, Gravett MG. Maternal serum glycosylated fibronectin as a point-of-care biomarker for assessment of preeclampsia. Am J Obstet Gynecol. 2015;212(1):82.
Huhn EA, Hoffmann I, Martinez De Tejada B, Lange S, Sage KM, Roberts CT, Gravett MG, Nagalla SR, Lapaire O. Maternal serum glycosylated fibronectin as a short-term predictor of preeclampsia: a prospective cohort study. BMC Pregnancy Childbirth. 2020;20(1):128.
Monte S. Biochemical markers for prediction of preclampsia: review of the literature. J Prenat Med. 2011;5(3):69-77.
Staff AC, Benton SJ, von Dadelszen P, Roberts JM, Taylor RN, Powers RW, Charnock-Jones DS, Redman CW. Redefining preeclampsia using placenta-derived biomarkers. Hypertension. 2013;61(5):932-42.
Poon LC, Nicolaides KH. First-trimester maternal factors and biomarker screening for preeclampsia. Prenat Diagn. 2014;34(7):618-27.
Kar M. Role of biomarkers in early detection of preeclampsia. J Clin Diagn Res. 2014;8(4):1-4.
Wu P, van den Berg C, Alfirevic Z, O'Brien S, Röthlisberger M, Baker PN, Kenny LC, Kublickiene K, Duvekot JJ. Early Pregnancy Biomarkers in Pre-Eclampsia: A Systematic Review and Meta-Analysis. Int J Mol Sci. 2015;16(9):23035-56.
Shruthi K, Pranathi R, Gayathri V, Prathyusha R, Bhargavi R. Glycosylated Fibronectin Point of care Test for Triage and Surveillance of Hypertension in Pregnancy Cases: A Retrospective Observational Case Control Study. J Obstet Gynecol India. 2021.
Nagalla SR, Janaki V, Vijayalakshmi AR, Chayadevi K, Pratibha D, Rao PV, Sage KM, Nair-Schaef D, Bean E, Roberts CT Jr, Gravett MG. Glycosylated fibronectin point-of-care test for diagnosis of pre-eclampsia in a low-resource setting: a prospective Southeast Asian population study. BJOG. 2020;127(13):1687-94.
Powers RW, Catov JM, Bodnar LM, Gallaher MJ, Lain KY, Roberts JM. Evidence of endothelial dysfunction in preeclampsia and risk of adverse pregnancy outcome. Reprod Sci. 2008;15(4):374-81.
Stubbs TM, Lazarchick J, Horger EO. Plasma fibronectin levels in preeclampsia: a possible biochemical marker for vascular endothelial damage. Am J Obstet Gynecol. 1984;150(7):885-7.
ACOG Practice Bulletin No. 202: Gestational Hypertension and Preeclampsia. Obstet Gynecol. 2019;133(1):1.
Mattar F, Sibai BM. Eclampsia. VIII. Risk factors for maternal morbidity. Am J Obstet Gynecol. 2000;182(2):307-12.
Sibai BM. Diagnosis, prevention, and management of eclampsia. Obstet Gynecol. 2005;105(2):402-10.
Kanani B, Garala NJ. A clinical observational study in cases of eclampsia. Int J Reprod Contracept Obstet Gynecol. 2019;8:3524-7.