Third-Trimester NT-proBNP for Pre-eclampsia Risk Prediction

• Published in: JACC: Advances
• Main Authors: Lucas Bacmeister, MD, Annette Buellesbach, MD, Dorte Glintborg, MD, PhD, Jan Stener Jorgensen, MD, PhD, Birgitte Møller Luef, MD, Anna Birukov, PhD, Adrian Heidenreich, MD, Diana Lindner, PhD, Till Keller, MD, Kristin Kraeker, PhD, Tanja Zeller, PhD, Ralf Dechend, MD, Marianne Skovsager Andersen, MD, PhD, Dirk Westermann, MD
• Format: Article
• Language: English
• Published: Elsevier 2025-04-01
• Subjects: cardio-obstetrics; hypertension; natriruretic peptides; pre-eclampsia; risk prediction
• Online Access: http://www.sciencedirect.com/science/article/pii/S2772963X25000882
• ISSN: 2772-963X

Background: The association between lower first-trimester N-terminal pro B-type natriuretic peptide (NT-proBNP) levels and increased pre-eclampsia risk remains poorly understood, contrasting with the elevated NT-proBNP levels observed at the time of pre-eclampsia diagnosis. Objectives: The aim of this study was to assess the utility of third-trimester NT-proBNP for assessing pre-eclampsia risk before onset. Methods: NT-proBNP and the soluble Fms-like tyrosine kinase 1 to placental growth factor ratio (sFlt-1/PlGF) were measured in 1,476 pregnant individuals from the Odense Child Cohort at a median gestational age of 29 weeks (Q1-Q3: 28.4-29.4). Pre-eclampsia cases were categorized by timing: 11 individuals (0.7%) developed pre-eclampsia within 4 weeks, while 110 (7.5%) developed pre-eclampsia more than 4 weeks after sampling. Results: Higher NT-proBNP levels were significantly associated with increased risk of pre-eclampsia within 4 weeks but reduced risk beyond 4 weeks. After adjusting for age, body mass index, nulliparity, systolic blood pressure, and the sFlt-1/PlGF ratio, the adjusted OR was 2.18 (95% CI: 0.88-5.42, P = 0.09) for onset within 4 weeks and 0.72 (95% CI: 0.55-0.93, P = 0.012) for onset beyond 4 weeks. However, combining NT-proBNP with the sFlt-1/PlGF ratio did not improve the predictive accuracy for short- or long-term pre-eclampsia risk compared to the sFlt-1/PlGF ratio alone. Conclusions: Unselected NT-proBNP screening in the early third trimester has limited clinical value for predicting short- or long-term pre-eclampsia risk when compared to angiogenic biomarkers.