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New Biomarker May Predict Severe Pre-eclampsia Complications

•Posted inObstetrics and Gynaecology

N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a crucial marker of cardiac stress. Therefore, researchers proposed it as a potential prognostic tool for adverse maternal outcomes in pre-eclampsia (PE). A recent retrospective cohort study evaluated the predictive value of NT-proBNP in pre-eclampsia for severe complications. This research offers vital insights for obstetricians regarding maternal risk stratification.

Study Methodology and Cohort

This study analyzed singleton pregnancies diagnosed with PE at or before 36 weeks of gestation. The research took place at the Medical University of Vienna between January 2018 and December 2023. Maternal serum levels of NT-proBNP were measured at the time of PE diagnosis. Soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) levels were also assessed. The primary outcome included severe adverse events like pulmonary edema, intensive care unit (ICU) admission, maternal death, and severe neurological complications.

NT-proBNP in Pre-eclampsia: Key Findings on Prognosis

Of the 130 women in the cohort, 10% (13 women) experienced severe maternal adverse outcomes. Consequently, NT-proBNP levels were significantly higher in this group. The median level was 688.0 pg/mL for the severe outcome group versus 106.1 pg/mL for the non-severe group. Importantly, a higher NT-proBNP Z-score was strongly associated with a severe adverse outcome (adjusted odds ratio, 3.24). Furthermore, the marker predicted a shorter time-to-delivery in severe cases. This result was achieved after adjusting for gestational age and the sFlt-1/PlGF ratio.

The study confirmed that NT-proBNP in pre-eclampsia demonstrated superior discriminative ability when compared to the sFlt-1/PlGF ratio alone. Combining NT-proBNP with gestational age further improved the prediction accuracy (Area Under the Curve, 0.82). Moreover, other studies show NT-proBNP levels increase with the severity of PE, with levels above 500 pg/mL linked to complications.

Clinical Implications for Indian Obstetric Practice

Pre-eclampsia represents a major health challenge in India, contributing substantially to maternal morbidity and mortality. Therefore, effective risk stratification tools are essential for timely management. The findings demonstrate that NT-proBNP, a readily available cardiac stress marker, serves as a strong, independent predictor of severe maternal outcomes. Moreover, it outperformed the sFlt-1/PlGF ratio in this cohort. Hence, integrating NT-proBNP measurement into the initial assessment of women diagnosed with PE can help clinicians identify those needing closer monitoring or expedited delivery. This approach ultimately facilitates timely intervention and improves maternal prognosis in high-risk settings.

Frequently Asked Questions

Q1: What specific adverse outcomes did the study associate with high NT-proBNP?

The study defined severe maternal adverse outcome as including ICU admission, maternal death, pulmonary edema, and severe neurological complications.

Q2: How did NT-proBNP perform against the sFlt-1/PlGF ratio?

NT-proBNP showed superior discriminative ability compared to the sFlt-1/PlGF ratio (AUC: 0.75 vs 0.67). Combining NT-proBNP with gestational age improved the predictive accuracy even further (AUC: 0.82).

Q3: Why is NT-proBNP considered a relevant biomarker in pre-eclampsia?

NT-proBNP is a marker of cardiac stress. Because pre-eclampsia causes cardiovascular malfunction and volume overload, elevated levels of NT-proBNP indicate ventricular stretch, reflecting the severity of the underlying maternal cardiovascular strain.

References

  1. Palmrich P et al. Prognostic value of maternal N-terminal pro-B-type natriuretic peptide for prediction of severe maternal adverse outcome in women with pre-eclampsia. Ultrasound Obstet Gynecol. 2025 Dec undefined. doi: 10.1002/uog.70129. PMID: 41206530.
  2. Wang C, et al. Serum Levels of N-Terminal Pro-Brain Natriuretic Peptide in Gestational Hypertension, Mild Preeclampsia, and Severe Preeclampsia: A Study from a Center in Zhejiang Province, China. Int J Mol Sci. 2021; 22(14):7555.
  3. Hafiz A, Dewantiningrum J, Kristanto H, Pramono MBA. Serum n-terminal pro b-type natriuretic peptide is associated with maternal complication in pregnancy with severe preeclampsia. Bali Medical Journal. 2021;10(1): 304–308.
  4. Prognostic value of maternal N-terminal pro-B-type natriuretic peptide for prediction of severe maternal adverse outcome in women with pre-eclampsia – PubMed. nih.gov.
  5. A Systematic Review of NT-proBNP as Prognostic Biomarker for Preeclampsia Complications. thejmch.com.