Home Increased B-type natriuretic peptide levels in early-onset versus late-onset preeclampsia
Article
Licensed
Unlicensed Requires Authentication

Increased B-type natriuretic peptide levels in early-onset versus late-onset preeclampsia

  • Gábor Szabó EMAIL logo , Attila Molvarec , Bálint Nagy and János Rigó Jr.
Published/Copyright: August 27, 2013

Abstract

Background: We compared B-type natriuretic peptide (BNP) levels, clinical and laboratory findings in early-onset preeclampsia (EOP), late-onset preeclampsia (LOP) and healthy pregnant groups.

Methods: We studied 40 healthy pregnant and 40 preeclamptic patients. Preeclamptics were divided in two groups, the EOP group (n=20) and LOP group (n=20), according to gestational age at the onset of disease. The distinction criterion for early- vs. late-onset was set as week 34 of gestation. The concentration of the BNP levels was measured by a sandwich fluorescence immunoassay. For statistical analysis of the clinical and laboratory findings non-parametric methods were applied.

Results: BNP levels were higher in EOP [61.35 (36.95–93.25) pg/mL] and LOP patients [32.4 (19.15–39.2) pg/mL] than in healthy pregnant women [10.05 (6.08–16.03) pg/mL] (both p<0.001). Furthermore, EOPs had significantly higher BNP levels as compared to LOP patients (p<0.001). A BNP cut-off <24.5 pg/mL had a negative-predictive value of 85.1% excluding preeclampsia. There was a significant inverse correlation between plasma BNP levels of EOP patients and sodium (p<0.05) and total protein concentrations (p<0.05). In the EOP group, a significant positive correlation was observed between plasma levels of BNP and hematocrit (p<0.05), serum potassium (p<0.05), urea (p<0.05) and 24-h proteinuria (p<0.05).

Conclusions: BNP levels were significantly higher in EOP than in LOP patients. The cut-off value <24.5 pg/mL seems to be a powerful discriminative indicator excluding preeclampsia. The amount of proteinuria and total protein levels correlate with the elevation of the BNP levels. In EOP the extent of proteinuria is higher than in the LOP.


Corresponding author: Dr. Gábor Szabó, First Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary Baross u. 27, Budapest, 1088 Hungary, Phone: +36 1 2660473/54248, Fax: +36 1 3176174, E-mail:

References

1. Sibai B, Dekker G, Kupferminc M. Pre-eclampsia. Lancet 2005;365:785–99.10.1016/S0140-6736(05)17987-2Search in Google Scholar

2. Steegers EA, von Daedelszen P, Duvekot JJ, Pijnenborg R. Pre-eclampsia. Lancet 2010;376:631–44.10.1016/S0140-6736(10)60279-6Search in Google Scholar

3. Bellamy L, Casas JP, Hingorani AD, Williams DJ. Preeclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta analysis. Br Med J 2007;335:974.10.1136/bmj.39335.385301.BESearch in Google Scholar PubMed PubMed Central

4. Resnik LJ, Hong C, Resnik R, Kazanegra R, Beede J, Bhalla V, et al. Evaluation of B-type natriuretic peptide (BNP) levels in normal and preeclamptic women. Am J Obstet Gynecol 2005;193:450–4.10.1016/j.ajog.2004.12.006Search in Google Scholar PubMed

5. Yurteri-Kaplan L, Saber S, Zamudio S, Srinivasan D, Nyirenda T, Alvarez M, et al. Brain natriuretic peptide in term pregnancy. Reprod Sci 2012;19:520–5.10.1177/1933719111426598Search in Google Scholar PubMed

6. Folk JJ, Lipari CW, Nosovitch JT, Silverman RK, Carlson RJ, Navone AJ. Evaluating ventricular function with B-type natriuretic peptide in obstetric patients. J Reprod Med 2005;50:147–54.Search in Google Scholar

7. Hamaoui A, Mercado R. Evaluation of B-type natriuretic peptide levels in singleton hypertensive minority women. J Reprod Med 2012;57:39–42.Search in Google Scholar

8. Tranquilli AL, Brown MA, Zeeman GG, Dekker G, Sibai BM. The definition of severe and early-onset preeclampsia. Statements from the International Society for the Study of Hypertension in Pregnancy (ISSHP). Preg Hy 2013;3:44–7.Search in Google Scholar

9. Publications Committee, Society for Maternal-Fetal Medicine, Sibai BM. Evaluation and management of severe preeclampsia before 34 weeks’ gestation. Am J Obstet Gynecol 2011;205:191–8.10.1016/j.ajog.2011.07.017Search in Google Scholar PubMed

10. Ogge G, Chaiworapongsa T, Romero R, Hussein Y, Kusanovic JP, Yeo L, et al. Placental lesions associated with maternal underperfusion are more frequent in early-onset than in late-onset preeclampsia. J Perinat Med 2011;39:641–52.10.1515/jpm.2011.098Search in Google Scholar PubMed PubMed Central

11. Kucukgoz Gulec U, Ozgunen FT, Buyukkurt S, Guzel AB, Urunsak IF, Demir SC, et al. Comparison of clinical and laboratory findings in early- and late-onset preeclampsia. J Matern Fetal Neonatal Med 2013;26:1228–33.10.3109/14767058.2013.776533Search in Google Scholar PubMed

12. Naicker T, Randeree IG, Moodley J, Khedun SM, Ramsaroop R, Seedat YK. Correlation between histological changes and loss of anionic charge of the glomerular basement membrane in early-onset pre-eclampsia. Nephron 1997;75:201–7.10.1159/000189532Search in Google Scholar PubMed

13. Ornaghi S, Tyurmorezova A, Algeri P, Giardini V, Ceruti P, Vertemati E, et al. Influencing factors for late-onset preeclampsia. J Matern Fetal Neonatal Med 2013;13:1299–302.10.3109/14767058.2013.783807Search in Google Scholar PubMed

14. ACOG practice bulletin. Diagnosis and management of preeclampsia and eclampsia. Number 33, Obstet Gynecol 2002;99:159–67.Search in Google Scholar

15. Joubert K. Standards of the body mass and body length of birth in Hungary on the basis of the 1990–1996 nation-wide liveborn data. Magy Noorv L 2000;63:155–63.Search in Google Scholar

16. BNP test for rapid quantification of B-type natriuretic peptide [package insert]. San Diego, CA: Biosite Diagnostics, 2000.Search in Google Scholar

17. Cheng V, Kazanegra R, Garcia A, Lenert L, Krishnaswamy P, Gardetto N, et al. A rapid bedside test for B-type peptide predicts treatment outcomes in patients admitted for decompensated heart failure: a pilot study. J Am Coll Cardiol 2001;37:386–91.10.1016/S0735-1097(00)01157-8Search in Google Scholar

18. Kazanegra R, Cheng V, Garcia A, Krishnaswamy P, Gardetto N, Clopton P, et al. A rapid test for B-type natriuretic peptide correlates with falling wedge pressures in patients treated for decompensated heart failure: a pilot study. J Card Fail 2001;7:21–9.10.1054/jcaf.2001.23355Search in Google Scholar

19. Clerico A, Zaninotto M, Prontera C, Giovannini S, Ndreu R, Franzini M, et al. State of the art of BNP and NT-proBNP immunoassays: the CardioOrmoCheck study. Clin Chim Acta 2012;414:112–9.10.1016/j.cca.2012.07.017Search in Google Scholar

20. Rafik Hamad R, Larsson A, Pernow J, Bremme K, Eriksson MJ. Assessment of left ventricular structure and function in preeclampsia by echocardiography and cardiovascular biomarkers. J Hypertens 2009;27:2257–64.10.1097/HJH.0b013e3283300541Search in Google Scholar

21. Gaber LW, Spargo BH, Lindheimer MD. Renal pathology in pre-eclampsia. Baillieres Clin Obstet Gynaecol 1994;8:443–68.10.1016/S0950-3552(05)80330-XSearch in Google Scholar

22. Gerstein HC, Mann JF, Yi Q, Zinman B, Dinneen SF, Hoogwerf B, et al. Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals. J Am Med Assoc 2001;286:421–6.10.1001/jama.286.4.421Search in Google Scholar PubMed

23. Wachtell K, Ibsen H, Olsen MH, Borch-Johnsen K, Lindholm LH, Mogensen CE, et al. Albuminuria and cardiovascular risk in hypertensive patients with left ventricular hypertrophy: the LIFE study. Ann Intern Med 2003;139:901–6.10.7326/0003-4819-139-11-200312020-00008Search in Google Scholar PubMed

24. Haraldsson B, Nystrom J, Deen WM. Properties of the glomerular barrier and mechanisms of proteinuria. Physiol Rev 2008;88:451–87.10.1152/physrev.00055.2006Search in Google Scholar PubMed

25. Codognotto M, Piccoli A, Zaninotto M, Mion M, Plebani M, Vertolli U, et al. Renal dysfunction is a confounder for plasma natriuretic peptides in detecting heart dysfunction in uremic and idiopathic dilated cardiomyopathies. Clin Chem 2007;53:2097–104.10.1373/clinchem.2007.089656Search in Google Scholar PubMed

26. Fox CS, Gona P, Larson MG, Selhub J, Tofler G, Hwang SJ, et al. A multi-marker approach to predict incident CKD and microalbuminuria. J Am Soc Nephrol 2010;21:2143–9.10.1681/ASN.2010010085Search in Google Scholar PubMed PubMed Central

27. Magnusson M, Jovinge S, Shahgaldi K, Israelsson B, Groop L, Melander O. Brain natriuretic peptide is related to diastolic dysfunction whereas urinary albumin excretion rate is related to left ventricular mass in asymptomatic type 2 diabetes patients. Cardiovasc Diabetol 2010;9:2.10.1186/1475-2840-9-2Search in Google Scholar

28. Onodera M, Nakamura M, Tanaka F, Takahashi T, Makita S, Ishisone T, et al. Plasma B-type natriuretic peptide is useful for cardiovascular risk assessment in community-based diabetes subjects: comparison with albuminuria. Int Heart J 2012;53:176–81.10.1536/ihj.53.176Search in Google Scholar

29. de Leeuw K, Nieuwenhuis MK, Niemeijer AS, Eshuis H, Beerthuizen GI, Janssen WM. Increased B-type natriuretic peptide and decreased proteinuria might reflect decreased capillary leakage and is associated with a better outcome in patients with severe burns. Crit Care 2011;15:R161.10.1186/cc10297Search in Google Scholar

30. Kaaja RJ, Leinonen A, Moore P, Yandle T, Frampton CM, Nicholls MG. Effect of changes in body posture on vasoactive hormones in pre-eclamptic women. J Hum Hypertens 2004;18:789–94.10.1038/sj.jhh.1001743Search in Google Scholar

31. Krabbendam I, Courtar DA, Janssen BJ, Aardenburg R, Peeters LL, Spaanderman ME. Blunted autonomic response to volume expansion in formerly preeclamptic women with low plasma volume. Reprod Sci 2009;16:105–12.10.1177/1933719108324136Search in Google Scholar

32. Borghi C, Esposti DD, Immordino V, Cassani A, Boschi S, Bovicelli L, et al. Relationship of systemic hemodynamics, left ventricular structure and function, and plasma natriuretic peptide concentrations during pregnancy complicated by preeclampsia. Am J Obstet Gynecol 2000;183:140–7.10.1016/S0002-9378(00)24854-0Search in Google Scholar

33. Brown MA, Wang J, Whitworth JA. The renin-angiotensin-aldosterone system in pre-eclampsia. Clin Exp Hypertens 1997;19:713–26.10.3109/10641969709083181Search in Google Scholar PubMed

34. Irani RA, Xia Y. The functional role of the renin-angiotensin system in pregnancy and preeclampsia. Placenta 2008;9:763–71.Search in Google Scholar

35. Fu L, Ge HL, Li J, Chen GY, Li YS, Xie RS, et al. Correlation of hyponatremia with plasma renin activity, antidiuretic hormone and brain natriuretic peptide in chronic heart failure. Zhonghua Xin Xue Guan Bing Za Zhi 2006;34:781–3.Search in Google Scholar

36. Valensise H, Vasapollo B, Gagliardi G, Novelli GP. Early and late preeclampsia: two different maternal hemodynamic states in the latent phase of the disease. Hypertension 2008;52:873–80.10.1161/HYPERTENSIONAHA.108.117358Search in Google Scholar PubMed

37. Carvajal JA, Delpiano AM, Cuello MA, Poblete JA. Mechanical stretch increases brain natriuretic peptide production and secretion in the human fetal membranes. Reprod Sci 2013;20:69–77.10.1177/1933719112459219Search in Google Scholar PubMed PubMed Central

38. Kuhn M. Endothelial actions of atrial and B-type natriuretic peptides. Br J Pharmacol 2012;166:522–31.10.1111/j.1476-5381.2012.01827.xSearch in Google Scholar PubMed PubMed Central

39. Khedun SM, Naicker T, Moodley J. Endothelin-1 activity in pregnancy. J Obstet Gynaecol 2002;22:590–3.10.1080/0144361021000020321Search in Google Scholar PubMed

40. Mastrogiannis DS, O’Brien WF, Krammer J, Benoit R. Potential role of endothelin-1 normal and hypertensive pregnancies. J Hum Hypertens 1992;6:61–4.Search in Google Scholar

41. Bussen S, Sütterlin M, Steck T. Plasma endothelin and big endothelin levels in women with severe preeclampsia or HELLP-syndrome. Arch Gynecol Obstet 1999;262:113–9.10.1007/s004040050238Search in Google Scholar PubMed

42. Slowinski T, Neumayer HH, Stolze T, Gossing G, Halle H, Hocher B. Endothelin system in normal and hypertensive pregnancy. Clin Sci 2002;103(Suppl 48):446S–9S.10.1042/CS103S446SSearch in Google Scholar PubMed

43. Prontera C, Zaninotto M, Giovannini S, Zuchelli GC, Pilo A, Sciacovelli L, et al. Proficiency testing project for brain natriuretic peptide (BNP) and the N-terminal part of the propeptide of NP (NT-proBNP) immunoassays: the CardioOrmocheck study. Clin Chem Lab Med 2009;47:762–8.10.1515/CCLM.2009.153Search in Google Scholar PubMed

44. Silver MA, Maisel A, Yancy CW, McCullough PA, Burnett JC Jr, Francis GS, et al. BNP Consensus Panel 2004: a clinical approach for the diagnostic, prognostic, screening, treatment monitoring, and therapeutic roles of natriuretic peptides in cardiovascular diseases. Congest Heart Fail 2004;10:1–30.10.1111/j.1527-5299.2004.03271.xSearch in Google Scholar PubMed

Received: 2013-4-23
Accepted: 2013-8-5
Published Online: 2013-8-27
Published in Print: 2014-2-1

©2014 by Walter de Gruyter Berlin Boston

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. The ten commandments of laboratory testing for emergency physicians
  4. Review
  5. Critical role of RAGE in lung physiology and tumorigenesis: a potential target of therapeutic intervention?
  6. Opinion Papers
  7. Do we really need high-sensitive troponin immunoassays in the emergency department? Definitely, yes!
  8. Do we really need high-sensitivity troponin immunoassays in the emergency department? Maybe not
  9. General Clinical Chemistry and Laboratory Medicine
  10. Cortisol and cortisone ratio in urine: LC-MS/MS method validation and preliminary clinical application
  11. Urinary neutrophil gelatinase-associated lipocalin (NGAL) excretion increases in normal pregnancy but not in preeclampsia
  12. Influence of urine volume on the assessment of intestinal permeability in affected children by multiple sugar probes
  13. Measurement of amino terminal propeptide of type III procollagen (PIIINP) employing the ADVIA Centaur platform. Validation, reference interval and comparison to UniQ RIA
  14. Cancer Diagnostics
  15. Enrichment and enumeration of circulating tumor cells by efficient depletion of leukocyte fractions
  16. Immunological screening for tumor cells in serous body fluids has added value with the CELL-DYN Sapphire
  17. Cardiovascular Diseases
  18. The value of clinical and laboratory diagnostics for chest pain patients at the emergency department
  19. The concentration of high-sensitivity troponin I, galectin-3 and NT-proBNP substantially increase after a 60-km ultramarathon
  20. Autoantibody prevalence with an improved immunoassay for detecting cardiac troponin-specific autoantibodies
  21. Increased B-type natriuretic peptide levels in early-onset versus late-onset preeclampsia
  22. Association of the GCKR rs780094 polymorphism with metabolic traits including carotid intima-media thickness in Japanese community-dwelling men, but not in women
  23. Infectious Diseases
  24. Analysis of antibody response (IgM, IgG, IgG3) to Chikungunya virus using panel of peptides derived from envelope protein for serodiagnosis
  25. Letters to the Editor
  26. A short story on how the H-index may change the fate of scientists and scientific publishing
  27. A new and effective way for preventing pre-analytical laboratory errors
  28. Digital immunofluorescence enables automated detection of antinuclear antibody endpoint titers avoiding serial dilution
  29. Multicenter method evaluation of the ARK™ Methotrexate Immunoassay
  30. Haemoglobinopathies in nonendemic areas in recent years
  31. Clinical implications of a recent adjustment to the high-sensitivity cardiac troponin T assay: some results
  32. Effect of recalibration of the hs-TnT assay on diagnostic performance
Downloaded on 17.9.2025 from https://www.degruyterbrill.com/document/doi/10.1515/cclm-2013-0307/html
Scroll to top button