Elevated serum FABP4 predicts preeclampsia in diabetic women

By Will Boggs MD

Elevated serum levels of fatty acid binding protein 4 (FABP4) in the first and second trimester are associated with an increased risk of preeclampsia in women with type 1 diabetes, researchers report.

"The findings of this report represent one more step in the journey to a screening test for preeclampsia," Dr. Valerie A. Holmes from Queen's University Belfast, U.K., told Reuters Health by email.

"Research such as that reported here on the biomarker FABP4 demonstrates that in the future we may be able to stratify women into different care pathways based on risk, ensuring that women receive monitoring that is appropriate to risk," she said.

Earlier studies have documented elevated FABP4 levels in women with preeclampsia or in those in whom preeclampsia developed later, but these studies excluded women with diabetes.

Dr. Holmes and colleagues used data from 710 women in the Diabetes and Preeclampsia Intervention Trial to examine the role of FABP4 as a potential biomarker for preeclampsia in women with type 1 diabetes.

Seventeen percent of these women developed preeclampsia, the researchers report in Diabetes Care, online September 14.

FABP4 levels at randomization (median gestation, 14 weeks) and at 26 weeks' gestation were significantly higher in women in whom preeclampsia developed later than in those in whom it did not develop.

Among women tested at or before 13 weeks' gestation, FABP4 levels were significantly higher in those who went on to develop preeclampsia compared with those who did not.

In the second trimester, the highest quarter of FABP4 serum levels independently predicted 2.87-fold increased odds of preeclampsia (p=0.03) compared with the lowest quarter.

Each doubling of the serum FABP4 levels were associated with a 40% increase in the odds of preeclampsia at 14 weeks' gestation (p=0.031) and a 60% increase at 26 weeks' gestation (p=0.017).

Addition of FABP4 to established risk factors improved the prediction of preeclampsia and increased discrimination between case patients and non-case patients in the second trimester.

"This research on FABP4 adds to previous work by our group on angiogenic factors and markers of glycemic control (HbA1c) in relation to predicting preeclampsia in women with type 1 diabetes," Dr. Holmes said.

"In the future," she added, "FABP4 could be measured alongside these other known biomarkers of preeclampsia and combined with maternal risk factors to produce a risk score for preeclampsia. Antenatal care pathways and patient management, for example, prescription of aspirin or frequency of review appointments, might be influenced by preeclampsia risk scores."

"Further research is now warranted to devise and test such a risk score for women with type 1 diabetes," she said.

SOURCE: http://bit.ly/2cSWt4R

Diabetes Care 2016.

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