Diagnostic Value of IGFBP-2 in Predicting Preeclampsia Before 20 Weeks of Pregnancy: A Prospective Nested Case-Control Study

Backgroud. Preeclampsia (PE) is a critical type of hypertensive disorder of pregnancy, which seriously affects maternal and infant health. The etiology of PE is unclear, and there is no clear prediction model. In this study, new biomarkers were identified before 20 weeks of gestation to construct an early PE prediction model. Purpose. To identify novel biomarker insulin-like growth factor binding protein-2 (IGFBP-2) associated with preeclampsia (PE) before 20 weeks of gestation and to explore the predictive value of plasma IGFBP-2 in PE. Methods. A prospective nested case-control investigation involving 122 PE patients and 122 normal controls (NC) that were matched 1 : 1 in terms of age and week of pregnancy was carried out in Guangzhou Women and Children’s Medical Center (Guangzhou, China, 2018030306) from April 2016 to December 2019. At 8 to 20 weeks, blood samples from the mother were taken. To calculate the correlations, univariate conditional logistic regression was employed. Results. Herein, 12 clinical indices were significantly different between the PE and NC groups (uric acid (UA), cystatin C (Cys C), aspartate aminotransferase (AST), glutamyl transpeptidase (γ-GT), total bilirubin (TB), prothrombin time (PT), red blood cell (RBC), hematocrit (HCT), red cell distribution width (RDW), platelets (PLT), mean platelet volume (MPV), and thrombocytocrit (PCT)). Compared with the NC group ( 36.79 ± 19.91 pg/mL), the expression level of IGFBP2 in the PE group ( 19.76 ± 19.40 pg/mL) before 20 weeks of pregnancy was significantly decreased ( P < 0.01 ). Two high-risk factors were found to be significantly associated with PE independently of confounders: anemia 4.35 (2.20-8.45) ( P < 0.01 ) and cesarean section history 8.25 (2.67-26.67) ( P < 0.01 ). As a result of the univariate logistic regression analysis, the following three variables were included in the final logistic regression model.: Y = − 18.841 − 0.085 × IGFBP ‐ 2 + 0.630 × RDW + 0.165 × AST + 0.863 × MPV . In comparison to IGFBP-2 alone as an independent predictor of PE ( AUC = 0.897 , 95% CI 0.830–0.964), the model’s discriminatory power was considerably higher ( AUC = 0.953 , 95% CI 0.911–0.995). Conclusion. Plasma IGFBP-2 before 20 weeks of pregnancy combined with high-risk factors and routine blood indexes has a high early predictive value for PE.