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CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2021; 81(09): 1047-1054
DOI: 10.1055/a-1475-4296
GebFra Science
Original Article

Influence of Pregnancy-Related Conditions on Human Epididymis Protein 4 Serum Levels in Comparison to CA 125 – a Prospective Cohort Trial

Auswirkungen von schwangerschaftsbedingten Erkrankungen auf den humanen Epididymis-Protein-4-Spiegel im Blut verglichen mit CA 125 – eine prospektive Kohortenstudie
Samira Abdel Azim
1   Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
,
Irene Mutz-Dehbalaie
1   Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
,
Verena Wieser
1   Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
,
Astrid Berger
1   Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
,
Bettina Böttcher
2   Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Innsbruck, Innsbruck, Austria
,
Heidi Fiegl
3   Department of Gynecology and Obstetrics, Laboratory for Clinical Biochemistry, Medical University of Innsbruck, Innsbruck, Austria
,
Christian Marth
1   Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
,
Andreas Widschwendter
1   Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
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Abstract

Introduction HE4 and CA 125, two established biomarkers for assessing adnexal masses in non-pregnant women, are hardly investigated in pregnancy, especially in pregnancy-associated conditions. The aim was to evaluate HE4 and CA 125 levels in the course of pregnancy and to assess the impact of pregnancy disorders, contractions and rupture of membranes on HE4 and CA 125 serum levels in order to use these parameters for evaluation of adnexal masses in pregnancy.

Patients and Methods Blood samples (n = 238) of 201 women seen at the Medical University of Innsbruck, Austria, were prospectively obtained during pregnancy and postpartum. Serum concentrations of HE4 and CA 125 were analyzed. ROMA index was calculated by the premenopausal formula.

Results HE4 serum levels were highest in the third trimester. Contractions (p < 0.001), rupture of membranes (p = 0.005) and pregnancy-associated diseases (p = 0.003) were associated with higher HE4 levels. As much as 97.5% of HE4 measurements remained below the recommended cut-off for premenopausal women (70 pmol/l). CA 125 levels were not altered by pregnancy-associated conditions. Generally, CA 125 exhibited a wider serum level variability, exceeding the established cut-off of 35 U/ml in 16.4%.

Conclusions HE4 serum levels are influenced by several pregnancy-related conditions leading to significantly higher levels in these cases. Despite differing medians according to trimester, the 95th percentile cut-offs and almost all maximum values during the entire course of pregnancy were below the established cut-off for premenopausal women. It was also superior to the performance of ROMA index. Therefore, HE4 can be used as a valuable negative predictive marker for the assessment of adnexal masses during pregnancy.

Zusammenfassung

Einleitung Die Änderungen von HE4 and CA 125, 2 etablierten Biomarkern für die Evaluierung von Adnextumoren in nicht schwangeren Frauen, wurden bislang kaum während der Schwangerschaft untersucht, vor allem nicht im Zusammenhang mit schwangerschaftsbedingten Erkrankungen. Ziel dieser Studie war es, den HE4- und CA-125-Serumspiegel im Verlauf der Schwangerschaft zu messen und die Auswirkungen von schwangerschaftsbedingten Erkrankungen, Wehentätigkeit und Blasensprung auf die HE4- und CA-125-Serumspiegel auszuwerten, um diese Parameter für die Evaluierung von Adnexbefunden während der Schwangerschaft einzusetzen.

Patienten und Methoden Von 201 Frauen, die an der Medizinischen Universität Innsbruck, Österreich vorstellig waren, wurden Blutproben (n = 238) prospektiv während der Schwangerschaft sowie nach der Entbindung entnommen. Die Serumkonzentrationen von HE4 und CA 125 wurden ausgewertet. Der jeweilige ROMA-Index wurde anhand der prämenopausalen Formel kalkuliert.

Ergebnisse Die höchsten Werte des HE4-Serumspiegels wurden im 3. Trimenon gemessen. Wehentätigkeit (p < 0,001), Blasensprung (p = 0,005) und schwangerschaftsbedingte Erkrankungen (p = 0,003) waren ebenfalls mit höheren HE4-Werte assoziiert. Fast 97,5% der gemessenen HE4-Werte blieben aber unter dem empfohlenen Cut-off-Wert für prämenopausale Frauen (70 pmol/l). Schwangerschaftsbedingte Erkrankungen hatten keine Auswirkung auf die Höhe der CA-125-Werte. Die Variabilität der Serumwerte war aber für CA-125-Werte größer, und bei 16,4% der Patientinnen wurde der etablierte Cut-off-Wert von 35 U/ml überschritten.

Schlussfolgerungen Mehrere schwangerschaftsbedingte Erkrankungen wirkten sich auf die HE4-Serumwerte aus, und die Serumwerte waren bei diesen Patientinnen signifikant erhöht. Obwohl sich die Medianwerte je nach Trimenon unterschieden, blieben die Cut-off-Werte des 95. Perzentils sowie fast alle Maximalwerte während der gesamten Schwangerschaftsdauer unter den etablierten Cut-off-Werten für prämenopausale Frauen. Die Leistungsfähigkeit dieser Werte übertraf sogar die Aussagekraft des ROMA-Indexes. Damit stellen HE4-Werte einen nützlichen negativen prädiktiven Marker bei der Einschätzung von Adnexbefunden während der Schwangerschaft dar.

Key words

HE4 - CA 125 - pregnancy - tumor marker - biomarker - adnexal mass

Schlüsselwörter

HE4 - CA 125 - Schwangerschaft - Tumormarker - Biomarker - Adnextumor

Supporting Information



Publication History

Received: 11 December 2020

Accepted after revision: 05 April 2021

Article published online:
13 September 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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