Glycosylated Fibronectin as a Novel Predictor for the Maternal and Fetal Complications of Preeclampsia

Objective: The aim of this study was 1) to evaluate glycosylated fibronectin (GlyFn) as a novel predictor for preeclampsia (PE)-related maternal and fetal complications, and 2) to compare the predictive value of GlyFn versus that of the soluble Fms-like tyrosine kinase-1/placental growth factor (PlGF) (sFlt-1/ PlGF) ratio. Design and method: This was a secondary analysis of a prospective multicenter cohort study involving 524 pregnancies either suspected of (but not confirmed with) PE, with gestational hypertension (GH), or with confirmed PE and/or HELLP syndrome (PE/HELLP). In all patients sFlt-1, PlGF and GlyFn were measured at the time of inclusion. Logistic regression was conducted to study the association between GlyFn and PE-related complications. A traditional model (incorporating gestational age at biomarker measurement, parity, diastolic blood pressure and proteinuria at inclusion), to which GlyFn and the other biomarkers were added, was used for multivariable analysis. Results: In GH and PE/HELLP, GlyFn levels were significantly elevated (P=0.002 and P=0.02, respectively), compared to women with suspected PE. GlyFn correlated positively with sFlt-1 and the sFlt-1/PlGF ratio, and negatively with PlGF. GlyFn alone performed better than the traditional model with regard to the prediction of maternal but not fetal complications, and this was also true for sFlt-1, PlGF and their ratio. Combining the traditional model with GlyFn increased the C-index for maternal complications further, and on top of the traditional model the GlyFn/PlGF ratio yielded the best results for predicting fetal complications in the overall cohort, while in women with a gestational age <37 weeks this was also true for the prediction of maternal complications. Conclusions: GlyFn is a novel biomarker for PE diagnosis and its complications, and its role might be particularly relevant in patients with PE below 37 weeks of gestation.