Placental Proteins in Gingival Crevicular Fluid and Periodontal Status as Early Predictors of Preeclampsia

Objectives: Preeclampsia (PE) affects around 5-7% of all pregnancies. Early detection of predisposition to PE is the first step in developing efficacious preventive treatment. Objective: to establish the utility of placental proteins presents in gingival crevicular fluid [GCF], and periodontal disease status as early pregnancy predictors of PE.
Methods: A prospective cohort was conducted. Pregnant healthy women at 11-14 weeks gestation were included. Samples of oral fluids were collected and a complete maternal/obstetric and periodontal history was obtained. Concentrations of Alkaline Placental Phosphatase (PLAP), Placental Growth Factor (PlGF) and soluble Fms-like tyrosine kinase 1 (sFlt-1) were measured by ELISA and LUMINEX assays. Multiple logistic regression models assessed the association. The evaluation for the diagnostic accuracy of the biomarkers was performed through ROC curves.
Results: 331 pregnant women were recruited. Of these, 15 women (i.e. 4.5%) developed PE. Significantly increased GCF-PLAP levels in pregnant women who later developed PE was observed (p= 0.0092). The median value was 51.82 (IQR 47.21) pg/ml for the group without PE and 84.19 (IQR: 44.81) pg/ml for PE group. There were no significant differences in GCF-PlGF (p=0,4563) and GCF-sFlt-1 levels (p=0,2467) in pregnant women who later developed PE. Multiple[AC1] logistic regression analyses demonstrate an association between initial systolic blood pressure (O.R: 1.06, p-value = 0.011 IC 95% 1.014-1.115), and GCF-PLAP (O.R: 1.014, p-value=0.003, IC 95% 1.005-1.024), AUC curve: 0.81 in women who developed PE. ). Aditionally, PLAP levels are not related with severity of periodontal disease (Healthy v/s Severe PD p=0.3457[AC2] ). However, PlGF and sFlt-1 levels are related with the severity of periodontal disease (PlGF: Healthy v/s Severe PD p=0.0170 ( sFlt-1 :Healthy v/s Severe PD p<0.0001).

Conclusions: The results support that first trimester maternal GCF-PLAP concentrations could be a surrogate biomarker for the future development of preeclampsia in pre-symptomatic women.