Maternal serum biomarkers and early pregnancy Doppler blood flow patterns

OBJECTIVES: This study aimed to evaluate the association between first‑trimester maternal serum biomarkers - β‑hCG, PAPP‑A, sFLT‑1, and PLGF - and Doppler ultrasound indices (uterine arteries and ductus venosus), and to determine their utility in predicting preeclampsia (PE). MATERIAL AND METHODS: In this prospective study (2021-2022) at University Hospital No. 2, Bydgoszcz, 137 pregnant women in the first trimester (11+0-13+6 weeks) were enrolled. Participants were assigned to an experimental group (n = 86, with PE risk factors) or a control group (n = 51). Serum levels of β‑hCG, PAPP‑A, PLGF, and sFLT‑1 were measured using electrochemiluminescence immunoassay, and Doppler ultrasound was used to assess uterine artery and ductus venosus blood flow. Mean arterial pressure (MAP) was recorded, and PE risk was calculated using FMF software. RESULTS: The experimental group had significantly lower PLGF levels (mean MoM 0.864 vs. 1.028, p = 0.0075) and higher sFLT‑1/PLGF ratios (34.32 vs 28.79, p = 0.0280) compared to controls. Additionally, MAP was significantly elevated (86.4 mmHg vs 79.5 mmHg, p < 0.0001) and the ductus venosus pulsatility index was lower (1.00 vs 1.07, p = 0.0132). Spearman analysis showed that increased PE risk correlated with lower PAPP‑A (R = -0.20, p = 0.0201) and PLGF (R = -0.54, p < 0.0001) and with a higher sFLT‑1/PLGF ratio (R = 0.40, p < 0.0001). CONCLUSIONS: Our findings support the utility of an integrated first‑trimester screening strategy that combines maternal risk factors, biochemical markers (PLGF and PAPP‑A), and biophysical parameters (MAP and Doppler indices) for early identification of pregnancies at elevated risk for PE. This approach may facilitate prophylactic interventions to improve maternal and perinatal outcomes.