First trimester serum afamin concentrations are associated with the development of pre-eclampsia and gestational diabetes mellitus in pregnant women

Objective: Aim of this study was to assess the prognostic capability of afamin to predict pregnancy complications. Method: First-trimester screening was consecutively performed in 4948 pregnant women, of whom 474 women developed pregnancy complications [gestational hypertension (n = 84), pre-eclampsia (n = 30), intrauterine growth restriction (n = 107), preterm birth (n = 44), and gestational diabetes mellitus (n = 209)]. To each woman with pregnancy complications an uncomplicated pregnancy was matched for body mass index. Afamin serum concentrations were measured in 948 pregnant women at the first-trimester screening. Results: Median afamin concentrations were significantly higher in women developing pre-eclampsia or gestational diabetes mellitus when compared to women with uncomplicated pregnancies (76 mg/L vs. 65 mg/L, p = 0.001 and 80 mg/L vs. 69 mg/L, p < 0.001). There was no difference in median afamin values between all other pregnancy complications and their matched controls. Increased afamin (i.e. > 65 mg/L) was a strong and independent predictor for the development of pre-eclampsia (risk ratio, 24.58; 95%CI, 2.82-214.12; p = 0.004) as well as gestational diabetes mellitus (risk ratio, 2.07; 95%CI, 1.33-3.22; p = 0.001). Conclusion: In this large nested case-control study increased afamin concentrations were a strong and independent predictor for pre-eclampsia and gestational diabetes mellitus, suggesting a potential role of afamin as predictive marker for pregnancy-related metabolic disorders.