Maternal Serum Soluble Endoglin in Patients with Pre-Eclampsia and Gestational Hypertension and its Relation to Doppler Study of the Fetomaternal Circulation

Bachground: Inadequate trophoblastic invasion and spiral artery remodelling leading to poor placental perfusion and hypoxia are believed to underlie preeclampsia. Recent studies implicate increased circulating endoglin (an anti-angiogenic factor produced due to placental hypoxia) as a contributer to the pathogenesis of preeclampsia. Objective: The objective of this study is to determine whether soluble Endoglin (sEng) concentrations are altered in pregnancies complicated with different hypertensive disorders of pregnancy as gestational hypertension and preeclampsia and to address its relation with Doppler study of the fetomaternal blood flow. Patients and Methods: We evaluated sEng level in sera of 30 patients with gestational hypertension and 30 patients with preeclampsia after diagnosis of the disease and compared them with 30 normal controls matched for gestational age, parity and BMI and correlated the results with fetomaternal blood flow as assessed by Doppler study. Results: There was significant association between blood pressure augmentation in different hypertensive diseases of pregnancy and soluble endoglin level in serum (9.2ng/ml in controls, 12.1ng/ml in gestational hypertension, 15.3ng/ml in pre-eclampsia). Also patients with abnormal umbilical artery Doppler velocimetry had the highest median serum concen-tration of sEng. Conclusion: Altered anti-angiogenic factor might be involved in the pathogenesis of the different hypertensive diseases of pregnancy. sEng had a good discriminatory ability between cases of preeclampsia, gestational hypertension and controls. Our data suggest that sEng level correlates positively with vascular dysfunction as evidenced by increased resistance to umbilical blood flow assessed by Doppler study with high sEng level. Our results are consistent with the hypothesis that angiogenic balance plays a role in maternal breast cancer risk reduction associated with blood pressure increases in pregnancy.