Interpretation
PLAP, a membrane-bound glycosylated enzyme, is highly expressed in the
syncytiotrophoblastic membranes during
gestation104,107. PLAP concentrations in maternal
plasma are significantly increased in pregnant women with hypertensive
disorders than in those with a normotensive
pregnancy101,126,127. Increased PLAP concentrations
associated with PE may be a result of placental dysfunction, and they
may also represent an informative biomarker of the syncytiotrophoblast
function66,126. During pregnancy,
syncytiotrophoblastic debris is normally shed into the maternal
circulation; however, shedding is significantly increased in pregnancies
complicated by PE75,105. Furthermore, replenishment of
the syncytiotrophoblast is intense, complicated by necrosis and
aponecrosis with increased liberation into the circulation of
syncytiotrophoblast-derived particles in PE66. In
light with our result, syncytiotrophoblast-derived particles, such as
PLAP, can reach the gingival sulcus during early pregnancy, and can be
detected in the GCF. Its concentrations are informative of the risk of
developing PE and may be potentially used in future multiparametric
algorithm for the prediction of the disease.
In recent years, systematic reviews and meta-analyses of randomized
clinical trials have suggested that low-dose aspirin administration,
particularly in the early stage of pregnancy (<16 weeks of
gestation), to women at high risk for PE is associated with a
significant risk reduction in the incidence of this
disease79,168–173. Furthermore, the ASPRE randomized
clinical trial80, inclusive of more than 1,600
participants, reported that administration of aspirin (150 mg /day)
between 11 and 14 weeks of gestation in patients screened for PE risk
significantly reduced the risk of preterm PE by 62% compared with
placebo [OR: 0.38 (95% CI: 0.20–0.74)]. This finding has been
recently confirmed by a systematic review and
meta-analysis81 of six randomized clinical
trials80,174–177. This evidence highlights the
importance of implementing effective predictive models to identify
patients at risk of developing PE for whom aspirin administration would
be of clinical benefit. The predictive model reported herein is based on
the measurement of a single biomarker in GCF and systolic blood
pressure; therefore, it is non-invasive and inexpensive. Moreover, it
displays a potential clinical utility in identifying women during early
pregnancy who are at increased risk for developing PE, especially
preterm PE, and, as such, warrants further clinical evaluation.