Association between first trimester plasma htra1 level and subsequent preeclampsia: A possible early marker?

•Preeclampsia affects 2–8% of pregnancies.•Preeclampsia is diagnosable after 20th week of gestation.•HtrA1 levels are higher at 12 weeks in women who will develop PE later.•HtrA1 is an early predictive marker of PE.•HtrA1 analysis may have a strong clinical relevance in terms of disease prevention. Preeclampsia (PE) is associated with risk of maternal and fetal mortality and morbidity. Several promising predictors of PE have been identified, but early pregnancy screening for PE remains insufficient, and randomized controlled trials that used biomarkers to identify high-risk women have been disappointed. Our aim is to identify a possible early marker of PE. 158 women attending a routine antenatal care visit were recruited from 2014 to 2016 and prospectively followed until delivery (14 of whom had a diagnosis of PE). We have tested the plasma concentration of High temperature requirement factor A1 (HtrA1) at 12 weeks of gestation by ELISA technique in order to identify women at risk for developing PE. A multiple logistic regression analysis was used to estimate the independent effect of women’ characteristics on the probability of developing PE. Likelihood ratio test and Hosmer-Lemeshow test were used to select the most parsimonious model and to evaluate the model’s goodness of fit. Predictiveness of preeclampsia was estimated by ROC curve. PE cases had significantly higher BMI, before and after pregnancy, shorter gestational age at delivery and higher HtrA1values than healthy women. In addition, higher HtrA1 values in the first trimester maternal plasma, BMI before pregnancy and gestational age at delivery are significantly associated with subsequent development of PE. ROC curve showed a good accuracy in predicting preeclampsia, with an AUC of 0.83. These results suggest the HtrA1 as early predictive marker of PE having a strong clinical relevance for disease prevention.