Application of cell-free fetal DNA for early evaluation of preeclampsia to reduce maternal mortality by low-cost method – A prospective cohort study

ABSTRACT

Adverse pregnancy outcomes such as preeclampsia are the leading cause of maternal morbidity and mortality in the world and its incidence is increasing. It has been observed in some studies that cell-free fetal DNA (cff DNA) is increased in maternal serum associated with preeclampsia. In the present study, we have tested whether the elevated amount of cff DNA in maternal plasma is associated with PE and development of new marker by the low-cost method to predict preeclampsia. Twenty-one pregnant women within the age group of 20–30 years attending for routine antenatal checkups at (G & O) antenatal OPD after 20 weeks with fulfilling the diagnostic criteria of preeclampsia were included in our study. Age-matched pregnant women without hypertension were included as controls. A complete clinical history and anthropometric observation showed that gravida (total number of pregnancy in a patient including present pregnancy), gestational age, gestational age at birth, birth weight in preeclampsia subjects were non-significantly lower than normotensive subjects. Blood analysis showed lower platelet count and higher creatinine level, bilirubin level, and liver enzyme activities in preeclampsia subjects in comparison to normotensive subjects. Identification of cell-free fetal DNA (cff DNA) in maternal plasma by using two in-house methods (phenol-chloroform-isopropanol and NaI) was found comparable and its content (GE/µL) in preeclampsia subjects were significantly higher than the normotensive subjects. Correlation analysis showed that APGAR score was significantly negatively correlated with both systolic and diastolic blood pressure and significantly positively correlated with gestational age and gestational age at birth; whereas, cff DNA was significantly positively correlated with blood pressure but significantly negatively correlated with platelet count. In conclusion, our study demonstrated that APGAR score, which is one of the indicators of physiologic maturity of the infant is severely affected by the causative factors of preeclampsia and cell-free fetal DNA quantification may be a promising marker for future adverse pregnancy outcome.