Apoptosis and proliferation in first trimester trophoblast of further complicated and uncomplicated pregnancies related to maternal serum screening markers.

Introduction: Differences in proliferation and apoptosis in term trophoblast as well as maternal serum markers (MSM) for Down's syndrome in early pregnancy are related to adverse pregnancy outcomes. We investigated proliferation and apoptosis in first trimester chorionic villous sampling (CVS) as well as MSM and related these to pregnancy outcome.

Materials And Methods: We selected 51 samples of first trimester chorionic villi of pregnancies later complicated by hypertensive disorders (HD) (n=36) and intra-uterine growth restriction (IUGR) (n=15) with matched controls. Immunohistochemistry (cleaved caspase-3 for apoptosis and MIB-1 for proliferation) was performed. Apoptosis- (AI) and proliferation-index (PI) were determined and proliferation-apoptosis index (PA) was calculated by PI/AI. First trimester serum screening (n=39), samples taken at the time of CVS (n=108) or regular second trimester serum screening samples (n=99) were examined.

Results: The IUGR group compared to the hypertensive disorders group shows an increase of AI (p<0.05) and decrease in PA (p<0.03). Correlation is seen between PAPP-A and PI, AFP and AI and hCG and PA (all p<0.05).

Conclusion: Proliferation and apoptosis differ already in first trimester placentas of pregnancies complicated by hypertensive disorders or IUGR. Serum screening markers show correlation with proliferation and apoptosis and a subsequent adverse pregnancy outcome.