Plasma endothelin-1 and mean arterial pressure in the prediction of pre-eclampsia

Objective: To determine whether increased first trimester plasma endothelin -1 and/or increased midtrimester mean arterial blood pressure detected in p regnant women who are foe of symptoms can predict the subsequent developmen t of pre-eclampsia. Method: Eighty pregnant women were successfully followe d from 10 weeks gestation until delivery. Pre-eclampsia and eclampsia devel oped in 29 and 2 women, respectively, whereas 49 women remained normotensiv e. Plasma endothelin-1 was determined in the first trimester (10-12 weeks g estation) by a competitive radioimmunoassay. Result: First trimester plasma endothelin-1 levels in pregnant women who subsequently developed mild, sev ere pre-eclampsia and eclampsia were significantly higher than those of pre gnant women who remained normotensive. The release of endothelin-l increase s with the severity of the disease, age, body mass index and mean arterial blood pressure. The predictive values of plasma endothelin-l for pre-eclamp sia were: sensitivity 96.8%, specificity 51%, positive predictive value 55. 5% and negative predictive value 91%, whereas those of MAP were 48.4, 45, 3 5.7 and 58%, respectively. Conclusion: Determination of first trimester pla sma endothelin level may be a valuable marker to identify 55.5% of individu als at high risk of developing pre-eclampsia, if combined with midtrimester MAP, the positive predictive value increases to 68.2%. (C) 2000 Internatio nal Federation of Gynecology and Obstetrics.