Serum and urine inhibin A but not free activin A are endocrine biomarkers of severe pre-eclampsia

Benjamin D. Hamar, Irina A. Buhimschi, Anna K. Sfakianaki, Christian M. Pettker, Lissa K. Magloire, Edmund F. Funai, Joshua A. Copel, Catalin S. Buhimschi

Research output: Contribution to journalArticlepeer-review

18 Scopus citations

Abstract

Objective: Elevation of total serum inhibin A and activin A has been interpreted as evidence of placental dysfunction in women who develop pre-eclampsia. We sought to evaluate serum and urine levels of inhibin A and free activin A in normal and hypertensive pregnancies. Study design: Inhibin A and free activin A were measured by immunoassay in simultaneously collected serum and urine samples from 75 women: (1) severe pre-eclampsia (n = 30); (2) mild pre-eclampsia (n = 11); (3) chronic hypertension (n = 9); (4) pregnant control women (n = 16); and (5) nonpregnant control women (n = 9). Urine levels were normalized to milligrams urine creatinine, and fractional excretions were calculated. Results: Serum and urine inhibin A were increased and fractional excretion was decreased in pregnancy. Serum, urine, and fractional excretion of inhibin A were increased in severe pre-eclampsia, compared with other gravidas. The only difference observed in free activin A was a decrease in serum free activin A in chronic hypertension, compared with severe pre-eclampsia and pregnant control women. Urine inhibin A showed the greatest discrimination between severe pre-eclampsia and pregnant control women: a cut-off of 45 pg/mg urine creatinine had 96.8% sensitivity, 87.5% specificity, and 93.6% accuracy. Women with urine inhibin A greater than 90 pg/mg urine creatinine had a 17-fold relative risk (95% confidence interval 9.7-459.5) of a clinically indicated delivery due to pre-eclampsia. Conclusion: Serum and urine levels of inhibin A are altered in severe pre-eclampsia. Urine inhibin A may have application in the diagnosis and management of pre-eclampsia. Those with chronic hypertension have lower serum but not urine free activin A levels, compared with severe pre-eclampsia and mild pre-eclampsia.

Original languageEnglish (US)
Pages (from-to)1636-1645
Number of pages10
JournalAmerican journal of obstetrics and gynecology
Volume195
Issue number6
DOIs
StatePublished - Dec 2006
Externally publishedYes

Keywords

  • Gestational hypertension
  • Kidney
  • Pregnancy

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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