Role of Metalloproteinases (PAPP-A and MMP-9) in first trimester prediction of pregnancy hypertension

Introduction: Pregnancy hypertension is reported to affect 2-12% women in India. Currently available diagnostic criteria is applicable after 20 th weeks of gestation, this delayed diagnosis is the possible cause of the associated adverse obstetrics outcomes, which can be minimized by early detection. In this study the role of MMP-9 and PAPP-A was assessed in the first trimester (11 +0 -13 + 6 ) for early prediction of pregnancy hypertension. Methodology: This study was a part of ongoing project of first trimester preeclampsia screening. In that project 2000 women were screened. Samples were taken in first trimester and women were followed till delivery. Out of 2000 women, 199 developed Gestational Hypertension, 1454 remained normotensive till term and remaining 347 were excluded. In the present study we have included 199 women who developed hypertension and 199 controls, who were normotensive till term (selected from cohort of 1454 women who were normotensive). Results: The first trimester serum levels of PAPP-A (p<0.001) and MMP-9 (0.039) were significantly low in women who developed hypertension as compared to women who were normotensive till term. A significant positive correlation (p=0.03) was observed between MMP-9 and PAPP-A. The Combined sensitivity, specificity and Positive predictive value (PPV) of PAPP-A and MMP-9 was found to be 74.5%, 70.2% and 75% respectively. Conclusion: Inadequate expression of PAPP-A and MMP-9 may result in incomplete or poor trophoblast invasion and subsequent complication of pregnancy hypertension. In our population we have found that first trimester assessment of PAPP-A and MMP-9 may potentially predict pregnancy hypertension.