Plasma P-selectin is elevated in the first trimester in women who subsequently develop pre-eclampsia

Objective To report plasma concentrations of the adhesion cell molecule P-s electin during pregnancy to determine the effect of subsequent development of hypertension and pre-eclampsia. Design A longitudinal study. Methods A longitudinal study involving 70 women followed up from early preg nancy; 20 who subsequently developed pre-eclampsia were compared with 24 wh o developed gestational hypertension and 26 normotensive women with normal obstetric outcome. The determination of citrate plasma soluble P-selectin l evels throughout pregnancy was performed using a commercial quantitative sa ndwich immunoassay kit. The temporal course of plasma P-selectin in the thr ee groups of subjects was analysed. Results There was no significant difference in mean plasma P-selectin conce ntration between normotensive and gestational hypertensive subjects at any stage of pregnancy. Using a cutoff level of 60 ng/mL, P-selectin concentrat ion at 10-14 weeks had a negative predictive value for pre-eclampsia of alm ost 99%. Mean plasma P-selectin concentrations were significantly elevated by 10-14 weeks in women who later developed preeclampsia (P < 0.001). Conclusions Our data support an inflammatory model for pre-eclampsia whereb y endothelial cell activation may be secondary to a primary inflammatory re sponse. Plasma P-selectin has significant potential as a first trimester cl inical marker of pre-eclampsia.