Variations in fibrinolytic parameters and inhibin‐A in pregnancy: related hypertensive disorders

• Published in: Journal of thrombosis and haemostasis 2008-02, Vol.6 (2), p.352-358
• Main Authors: SARTORI, M. T., SERENA, A., SAGGIORATO, G., CAMPEI, S., FAGGIAN, D., PAGNAN, A., PATERNOSTER, D. M.
• Format: Article
• Language: English
• Subjects: inhibin‐A; PAI‐1; PAI‐2; placental dysfunction; pregnancy‐induced hypertension; pre‐eclampsia
• ISSN: 1538-7933; 1538-7836; 1538-7836
• DOI: 10.1111/j.1538-7836.2008.02840.x

Background: The mechanisms leading to pregnancy‐related hypertensive disorders, and pregnancy‐induced hypertension (PIH) and pre‐eclampsia (PE) in particular, are still not clear. Diagnostic criteria are clinical because specific markers of the condition are lacking. A role of the fibrinolytic system has been suggested. Objectives: We aimed to evaluate the behavior of tissue‐type plasminogen activator (t‐PA), plasminogen activator inhibitor type 1 (PAI‐1), PAI‐2, and the placental hormone inhibin‐A in women with a normal pregnancy vs. women with pregnancies complicated by PIH or PE. Methods: Blood samples were drawn between the 25th and 30th gestational week (GW) and between the 31st and 36th GW in order to assay t‐PA, PAI‐1, PAI‐2 and inhibin‐A; routine biochemical exams, ultrasonography umbilical artery pulsatility index (PI), placental weight and newborn weight were measured. Results: In pregnancies complicated by hypertensive disorders, PAI‐1 levels were higher than in controls and increased significantly after the 25th GW, especially in PE, as did inhibin‐A. PAI‐2 levels were significantly lower after the 30th GW in patients with PIH and PE. The PAI‐1/PAI‐2 ratio was significantly higher in PE patients than in controls as of the 25th GW, but only after the 30th GW in patients with PIH. Inhibin‐A was significantly correlated with fibrinolytic parameters, and inversely with newborn weight. Receiver–operator characteristic curves for PAI‐1 and inhibin‐A showed a high sensitivity and specificity for PE. PAI‐2 correlated with newborn and placental weight, and inversely with PI of the umbilical artery. Conclusions: Fibrinolytic tests (especially PAI‐1) and inhibin‐A monitoring during pregnancy may help in the early diagnosis of pregnancy‐related hypertensive disorders.