Soluble endoglin may predict stillbirth risk among pregnant women with pregnancy induced hypertension: Study

Risk factors associated with HDP include advanced maternal age, maternal obesity, chronic hypertension, primiparity, multifoetal gestation and maternal behaviours such as alcohol or drug abuse. Pregnancy-induced hypertension (PIH) is an important subset of the broad spectrum of HDP. The underlying pathophysiology of PIH is not fully understood, but is thought to be associated with impaired placental function in early pregnancy and progressive endothelial dysfunction.

PIH has implications for both maternal and foetal outcomes with the placenta serving as a connection between the two entities. Placental angiogenesis plays a pivotal role in establishing the foeto-maternal circulation.6 Failure of remodelling of the uterine spiral artery culminates in the formation of an abnormal placental bed. PIH impedes placental perfusion which results in vascular, occlusive as well as inflammatory lesions of the placenta which may progress to placental ischemia and later placental infarction. These lesions have been correlated with foetal growth restriction in preterm foetuses and may also play a major role in foetal and neonatal deaths. Ultimately, abnormal placentation hinders foetal growth and significantly contributes to unfavourable birth outcomes including intrauterine growth restriction, small-for-gestational age, preterm birth, and stillbirths.

Placentas in pregnancies affected by PIH exhibit an increase in anti-angiogenic proteins that could serve as markers of adverse birth outcomes. Use of relevant biomarkers could aid in effective diagnosis, therefore preventing fatal consequences. This study aimed to explore the association between maternal serum levels of soluble endoglin (sEng) and stillbirths in pregnancies complicated by PIH.

This case-control study utilized a total of 150 blood samples collected on admission for delivery comprising 50 cases of stillbirths, 50 preterm livebirths (preterm controls) and 50 term livebirths (term controls). The sEng levels were measured in the maternal serum using an enzyme linked immunosorbent assay (ELISA).

The sEng levels were markedly elevated in the cases [Median (Q1, Q3): 21] compared to the term controls [Median (Q1, Q3):14] with stillbirth samples demonstrating the highest concentrations of sEng compared to samples from the preterm and term livebirths (p-value<0.001). The findings also showed significant associations between the gestational ages of the participants and birthweights of the infants across the three study groups. Thus, predelivery sEng levels may be associated with stillbirth risk.

This study indicates an association between pre-delivery maternal serum levels of sEng in women with stillbirths affected by PIH compared to women with preterm livebirths and term livebirths without PIH.

Source: Patil et al. / Indian Journal of Obstetrics and Gynecology Research 2025;12(4):662–668