NT-proBNP Levels Signal Higher Maternal–Fetal Risk in Hypertensive Pregnancies: Study
Romania: Researchers have identified N-terminal pro–brain natriuretic peptide (NT-proBNP) as a useful predictive and prognostic biomarker for maternal–foetal complications in hypertensive disorders of pregnancy, with a threshold of 200 pg/mL signaling a significantly higher risk. The findings, published in the Journal of Clinical Medicine, suggest that combining NT-proBNP with established angiogenic markers could strengthen risk stratification in pregnant women with hypertension.
The study was led by Diana Mocuta from the Department of Obstetrics and Gynecology, University of Oradea, Romania, and addresses an important clinical gap. Hypertensive disorders of pregnancy, including preeclampsia, remain a leading cause of maternal and perinatal morbidity worldwide. Although angiogenic markers such as the soluble fms-like tyrosine kinase 1/placental growth factor (sFlt-1/PlGF) ratio are increasingly used for risk assessment, access to these tests is limited in many healthcare settings. This has prompted interest in more widely available and affordable biomarkers.
In the prospective, multicentre observational study, the researchers enrolled 180 pregnant women after 20 weeks of gestation between 2024 and 2025 at two Romanian hospitals. Participants had singleton pregnancies, complete clinical and laboratory data, and no medical conditions known to influence NT-proBNP or angiogenic marker levels.
They were categorized into three groups: preeclampsia (95 women; mean age 31.8 years), non-preeclampsia hypertensive disorders of pregnancy, such as gestational or chronic hypertension (25 women; mean age 30.5 years), and healthy controls (60 women; mean age 28.7 years).
NT-proBNP levels and the sFlt-1/PlGF ratio were measured mainly during the second and third trimesters. The investigators evaluated their associations with proteinuria, serum creatinine, serum uric acid, and the occurrence of maternal–foetal complications. Multivariable analyses were adjusted for maternal age, body mass index, and gestational age.
The researchers reported the following findings:
- Women with preeclampsia had significantly higher median NT-proBNP levels compared with those with other hypertensive disorders and healthy pregnancies.
- NT-proBNP levels were positively correlated with markers of disease severity, including proteinuria, renal dysfunction, uric acid levels, and the sFlt-1/PlGF ratio.
- An NT-proBNP level of 200 pg/mL or higher was independently associated with approximately threefold increased odds of maternal–foetal complications.
- At the 200 pg/mL threshold, NT-proBNP showed good diagnostic performance with an area under the curve of 0.78, sensitivity of 80%, and specificity of 71%.
- Combining NT-proBNP with the sFlt-1/PlGF ratio further improved risk prediction.
- The combined model demonstrated better discrimination than angiogenic testing alone, highlighting the complementary prognostic value of NT-proBNP.
According to the authors, NT-proBNP could serve as a practical tool for earlier and more refined risk assessment in hypertensive pregnancy disorders. In settings where angiogenic testing is unavailable, elevated NT-proBNP levels may help clinicians identify women who need closer monitoring, timely referral, or individualized management, potentially improving outcomes in high-risk pregnancies.
Reference:
Mocuta, D., Aur, C., Zaha, I. A., Nistor Cseppento, C. D., Sachelarie, L., & Huniadi, A. (2026). NT-proBNP as a Predictive and Prognostic Biomarker for Complications in Hypertensive Pregnancy Disorders. Journal of Clinical Medicine, 15(2). https://doi.org/10.3390/jcm15020519
Next Story