Bacmeister Lucas, Buellesbach Annette, Glintborg Dorte, Jorgensen Jan Stener, Møller Luef Birgitte, Birukov Anna, Heidenreich Adrian, Lindner Diana, Keller Till, Kraeker Kristin, Zeller Tanja, Dechend Ralf, Skovsager Andersen Marianne, Westermann Dirk
Clinic for Cardiology and Angiology, University Heart Center Freiburg - Bad Krozingen, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Clinic for Cardiology and Angiology, University Heart Center Freiburg - Bad Krozingen, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
JACC Adv. 2025 Apr;4(4):101671. doi: 10.1016/j.jacadv.2025.101671. Epub 2025 Mar 19.
The association between lower first-trimester N-terminal pro B-type natriuretic peptide (NT-proBNP) levels and increased pre-eclampsia risk remains poorly understood, contrasting with the elevated NT-proBNP levels observed at the time of pre-eclampsia diagnosis.
The aim of this study was to assess the utility of third-trimester NT-proBNP for assessing pre-eclampsia risk before onset.
NT-proBNP and the soluble Fms-like tyrosine kinase 1 to placental growth factor ratio (sFlt-1/PlGF) were measured in 1,476 pregnant individuals from the Odense Child Cohort at a median gestational age of 29 weeks (Q1-Q3: 28.4-29.4). Pre-eclampsia cases were categorized by timing: 11 individuals (0.7%) developed pre-eclampsia within 4 weeks, while 110 (7.5%) developed pre-eclampsia more than 4 weeks after sampling.
Higher NT-proBNP levels were significantly associated with increased risk of pre-eclampsia within 4 weeks but reduced risk beyond 4 weeks. After adjusting for age, body mass index, nulliparity, systolic blood pressure, and the sFlt-1/PlGF ratio, the adjusted OR was 2.18 (95% CI: 0.88-5.42, P = 0.09) for onset within 4 weeks and 0.72 (95% CI: 0.55-0.93, P = 0.012) for onset beyond 4 weeks. However, combining NT-proBNP with the sFlt-1/PlGF ratio did not improve the predictive accuracy for short- or long-term pre-eclampsia risk compared to the sFlt-1/PlGF ratio alone.
Unselected NT-proBNP screening in the early third trimester has limited clinical value for predicting short- or long-term pre-eclampsia risk when compared to angiogenic biomarkers.
孕早期较低的N端前脑钠肽（NT-proBNP）水平与子痫前期风险增加之间的关联仍未得到充分理解，这与子痫前期诊断时观察到的NT-proBNP水平升高形成对比。
本研究的目的是评估孕晚期NT-proBNP在子痫前期发病前评估风险的效用。
对来自欧登塞儿童队列的1476名孕妇在孕29周（第一四分位数-第三四分位数：28.4-29.4）时测量NT-proBNP和可溶性Fms样酪氨酸激酶1与胎盘生长因子的比值（sFlt-1/PlGF）。子痫前期病例按发病时间分类：11名个体（0.7%）在4周内发生子痫前期，而110名个体（7.5%）在采样后4周以上发生子痫前期。
较高的NT-proBNP水平与4周内子痫前期风险增加显著相关，但与4周后风险降低相关。在调整年龄、体重指数、未生育、收缩压和sFlt-1/PlGF比值后，4周内发病的调整后比值比为2.18（95%置信区间：0.88-5.42，P=0.09），4周后发病的调整后比值比为0.72（95%置信区间：0.55-0.93，P=0.012）。然而，与单独使用sFlt-1/PlGF比值相比，将NT-proBNP与sFlt-1/PlGF比值结合并不能提高对子痫前期短期或长期风险的预测准确性。
与血管生成生物标志物相比，在孕晚期早期进行非选择性NT-proBNP筛查预测子痫前期短期或长期风险的临床价值有限。
