Placental Proteins as Predictive Markers for Maternal Cardiovascular Risk Postpartum Following Preeclampsia

Abstract

Preeclampsia (PE) is a placenta-mediated hypertensive disorder which is also associated with an increase in the future cardiovascular risk in moms. Previous studies have shown that there are three subclasses of PE, ”Maternal adaptation” which lacks any clinical disease, ”Hypoxic” which has an upregulation in the levels of sFLT-1 and ENG and ”Inflammatory” which as elevation in the levels of CD68. In this study, we explore if these subclass-specific biomarkers can be used to predict the lifetime cardiovascular risk after PE. 58 women (PE=48, control=10) were recruited at the Ottawa General Hospital. Immunohistochemistry analysis was performed on placental tissue biopsies from 35 women with PE and six controls for FLT-1, ENG and CD68, their placental histopathology samples were collected at the time of delivery. After six months, they underwent a cardiovascular risk assessment and were stratified into high and low-risk groups. ImageJ and QuPath were used to quan tify biomarker expression. Logistic regression and receiver operator curve analysis assessed the association between PE subclass and CVD risk. Individually, no significant differences were observed in the biomarkers; upon combining them, they could predict the risk with 58% accuracy. When clinical, pathological and biomarker data were used together, the model could predict the risk with an accuracy of 86.3%. Although no differences in car diovascular risk were observed between PE subclasses, they should continue to be explored as their inclusion in clinical models enhances accuracy. This can be used a cost-effective method to identify women with higher CVD risk. These results support the use of unique placenta features to predict lifetime CVD risk following PE.