Clinical Value of Serum APOC1, LMNA, and TPM4 in Predicting Fetal Cardiac Abnormalities in Elderly Parturients

Q: What are the key findings of this study?

A combined prediction model using maternal serum APOC1, LMNA, and TPM4 levels demonstrated high predictive value for identifying fetal cardiac abnormalities in elderly parturients, achieving an AUC of 0.906.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Fetal cardiac structural abnormalities (n=108). Intervention: Serum APOC1, LMNA, and TPM4 levels vs. Individual indicator detection. Primary outcome: Prediction of fetal cardiac abnormalities using a combined model of APOC1, LMNA, and TPM4 (AUC 0.906, 95% CI 0.847-0.965, p=<0.05).

Q: What does this research mean for the field?

A combined panel of maternal serum APOC1, LMNA, and TPM4 levels independently predicts fetal cardiac abnormalities in elderly parturients with high diagnostic accuracy (AUC = 0.906). Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate the clinical performance of maternal serum APOC1, LMNA, and TPM4 levels in predicting fetal cardiac abnormalities among pregnant women aged 35 years and older.

Wei Wang; B Zhang; Linlin Fan; Man Lu; 侯巧芳

doi:10.2147/ijwh.s607411

July 1, 2026International Journal of Women s HealthOpen Access

Clinical Value of Serum APOC1, LMNA, and TPM4 in Predicting Fetal Cardiac Abnormalities in Elderly Parturients

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Key result

Maternal APOC1, LMNA, and TPM4 panel predicts fetal cardiac abnormalities with ~0.91 AUC.

AUC 0.906
95% CI 0.847-0.965
P<0.05
n=108

Figures

Why the study?

The clinical value of serum APOC1, LMNA, and TPM4 in predicting fetal cardiac abnormalities in elderly parturients was unclear.

Does the combined detection of maternal serum APOC1, LMNA, and TPM4 predict fetal cardiac abnormalities in high-risk elderly pregnant women?

Key Points

To evaluate the clinical performance of maternal serum APOC1, LMNA, and TPM4 levels in predicting fetal cardiac abnormalities among pregnant women aged 35 years and older.
Retrospective study of 108 pregnant women aged ≥ 35 years suspected of fetal heart abnormalities, categorized into a normal group (n=42) and an abnormal group (n=66).
Maternal blood samples collected at 18–24 weeks of gestation were analyzed for APOC1, LMNA, and TPM4 selected from 10 cardiac-related proteins.
Logistic regression modeling was utilized to generate a joint prediction model and adjust for early pregnancy folic acid supplementation history.
In the abnormal group, APOC1 levels were significantly higher (3.89 ± 0.65 vs. 2.35 ± 0.42 ng/mL, P<0.001), while LMNA (1.21 ± 0.28 vs. 2.03 ± 0.35 ng/mL, P<0.001) and TPM4 (0.87 ± 0.19 vs. 1.56 ± 0.26 ng/mL, P<0.001) were significantly lower than in controls.
After adjusting for folic acid supplementation, APOC1 (OR=1.85, 95% CI: 1.32–2.59, P<0.001), LMNA (OR=0.52, 95% CI: 0.38–0.71, P<0.001), and TPM4 (OR=0.41, 95% CI: 0.28–0.60, P<0.001) independently predicted fetal cardiac abnormalities.
The joint three-protein prediction model achieved an AUC of 0.906 (95% CI: 0.847–0.965), with a sensitivity of 98.49% and a specificity of 76.19%, outperforming each individual biomarker alone (all P<0.05).

Study Design

Type

Cohort (n=108)

Blinding

Outcome assessor blinded

Multicenter

No

Structured PICO

Does the combined detection of maternal serum APOC1, LMNA, and TPM4 predict fetal cardiac abnormalities in high-risk elderly pregnant women?

P

Population

108 elderly pregnant women (≥35 years) with suspected fetal cardiac abnormalities who underwent mid-pregnancy biomarker testing and were followed until up to 42 days postpartum.

E

Exposure

Combined detection of maternal serum APOC1, LMNA, and TPM4 using a logistic regression predictive model.

C

Comparator

Individual detection of serum APOC1, LMNA, or TPM4 alone.

O

Outcome

Fetal cardiac abnormalities, confirmed by neonatal echocardiography within 42 days after birth or pathological anatomical examination after induced abortion (measured as diagnostic performance via AUC).

Main Result

Effect estimate: AUC 0.906 (95% CI 0.847-0.965)

p-value: p=<0.05

The combined measurement of maternal serum APOC1, LMNA, and TPM4 provides a highly accurate, non-invasive biomarker model for predicting fetal congenital structural heart abnormalities in high-risk elderly pregnant women.

Limitations

Single-center retrospective design may introduce selection bias.
Relatively small sample size limits the statistical power of subgroup analysis and model stability.
Pre-selected high-risk population, meaning results cannot be directly generalized to the broader pregnant population.
The combined prediction model lacks external validation in an independent cohort.
Potential for unmeasured residual confounding factors such as nutritional status and environmental exposure.
Potential temporal bias between serum sample collection and ultrasound evaluation due to the retrospective nature of the study.
Retrospective design
Lack of external validation
Limited sample size

Implication

May support noninvasive fetal cardiac anomaly prediction in older parturients; hypothesis-generating pending prospective validation.

Abstract

Objective: This study aimed to explore the clinical value of serum APOC1, LMNA, and TPM4 in predicting fetal cardiac abnormalities in elderly parturients. Methods: A retrospective study was conducted on 108 elderly (≥ 35 years old) pregnant women suspected of having fetal heart abnormalities (high-risk cohort). They were divided into a normal group (42 cases) and an abnormal group (66 cases). APOC1, LMNA, and TPM4 with significant differences were selected from 10 cardiac related proteins in blood samples collected at 18-24 weeks of pregnancy. A combined prediction model was constructed using logistic regression. Results: In the abnormal group, APOC1 level was increased, but LMNA and TPM4 levels were decreased compared with the normal group (both P<0.05). The level of APOC1 was elevated, but LMNA and TPM4 levels were declined with the severity of cardiac abnormalities,(P<0.05). After adjusting for folate supplementation history, APOC1 (OR=1.85), LMNA (OR=0.52), and TPM4 (OR=0.41) were independent predictors of fetal cardiac abnormalities (all P<0.001). The AUC of the joint model for predicting fetal cardiac abnormalities was 0.906, with a sensitivity of 98.49% and a specificity of 76.19%, all of which were superior to individual indicator (P<0.05). Conclusion: The combined detection of APOC1, LMNA, and TPM4 has high predictive value for fetal cardiac abnormalities in elderly mothers, but external validation is needed to confirm clinical applicability.

Discussion

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Cite This Study

Wang et al. (2026) conducted a cohort in Fetal cardiac structural abnormalities (n=108). Serum APOC1, LMNA, and TPM4 levels vs. Individual indicator detection was evaluated on Prediction of fetal cardiac abnormalities using a combined model of APOC1, LMNA, and TPM4 (AUC 0.906, 95% CI 0.847-0.965, p=<0.05). A combined prediction model using maternal serum APOC1, LMNA, and TPM4 levels demonstrated high predictive value for identifying fetal cardiac abnormalities in elderly parturients, achieving an AUC of 0.906.

synapsesocial.com/papers/6ad0fc2515427f6a8403ff54 https://doi.org/10.2147/ijwh.s607411

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Clinical Value of Serum APOC1, LMNA, and TPM4 in Predicting Fetal Cardiac Abnormalities in Elderly Parturients

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Clinical Value of Serum APOC1, LMNA, and TPM4 in Predicting Fetal Cardiac Abnormalities in Elderly Parturients

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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