The role of polyamines in noninvasive diagnosis of placenta-associated pregnancy complications

Relevance: Polyamines are organic molecules involved in regulating systemic inflammatory responses, cell growth, and cell division. Noninvasive diagnosis of fetal growth restriction (FGR) and preeclampsia (PE) with determination of urinary polyamine levels is a promising method for the prediction, early detection, and monitoring of obstetric complications.

Objective: To investigate the characteristics of urine polyamine profiles in pregnant women with FGR and PE in order to identify biomarkers with prognostic and diagnostic potential.

Materials and methods: This study analyzed urine polyamines obtained from 73 pregnant women. The PE group included 22 pregnant women, the FGR group included 30 women, and the control group included 21 healthy women without pregnancy-related complications. Polyamine levels were determined by liquid chromatography with mass spectrometric detection.

Results: The study identified significant multidirectional changes in the metabolites studied, depending on obstetric complications (PE or FGR). For putrescine and its ketone derivative N-acetylputrescine, the change was statistically significant; however, while putrescine levels were higher in both the PE and FGR groups than in the control group, N-acetylputrescine levels were lower in both pathology groups, with slightly higher concentrations in the PE group (p=0.05). Compared to the controls, the level of 1,7-diaminoheptane was increased in patients with FGR and decreased in patients with PE (p = 0.04). For the timely verification of placenta-associated pregnancy complications based on the established levels of urine polyamines, predictive models were built with a high sensitivity of 1 (1; 1) and specificity of 1 (1; 1), with an area under the AUC curve of 1 and a threshold value of 0.5.

Conclusion: Noninvasive determination of the level of urine polyamines during FGR and PE over time may become an important marker of the severity of these pregnancy complications and help in choosing the management strategy and timing of delivery in this cohort of patients.