O20. NT-pro-BNP levels as a marker of high clinical risk in pregnancy

Introduction NT-pro-BNP proved to be a useful prognostic marker of unfavorable outcome in cardiac failure. There were few data about its clinical significance in pregnant women (PW) and maternal health prognosis, correlated to adverse events during pregnancy. Objectives Evaluate the correlation between NT-pro-BNP levels and primary end-points: death, HELLP, preeclampsia and cardiac failure in PW. Methods We analyzed prospectively 218 asymptomatic PW who consulted Private Hospital between 2009 and 2015. Patients with diabetes, renal chronic failure and cardiac disease were excluded. We performed: clinical and cardiological evaluation, blood and urine determinations included NT-pro-BNP. PW were followed-up during pregnancy and post-delivery. Association between: death, HELLP, preeclampsia and cardiac failure, as combined end-points were evaluated during follow-up and confronted by statistical analysis with NT-pro-BNP levels during follow-up. The best cutoff point value for NT-pro-BNP was 125 pg/ml. Statistical analyses was performed: chi-square test for parametrical nominal data, Fisher’s exact test with Yates correction. Results PW average age was 33.7 years, 106 PW had Hypertensive Gestational Syndromes (HGS), in this group: gestational age at delivery 35.2 weeks, birth average weight 2469.6 gr, first pregnancy 50%, fetal growth restriction 18.5%, oligoamnios 21.2%, stillbirth 5.3%, maternal cardiac failure 6%, peripartum cardiopathy 1%. NT-pro-BNP average in HGS: 646.7 pg/ml, non HGS: 60.3 pg/ml. In this population: in 140 PW (69.4%) NT-pro-BNP was below 125 pg/ml, and 78 PW (30.6%) above this value. In the group with NT-pro-BNP above 125 pg/ml 71 PW (75.2%) showed combined end-point vs. 35 PW (24.7%) in the NT-pro-BNP normal value group, with a significant statistical association ( p 0.001) by chi-square correlation 59.21 df, Cramer’s V 0.6887, OR 0.82 (CI 0.56–0.92) showing a negative predictive value in the prospective follow-up. There was no correlation between NT-pro-BNP and fetal health. Conclusion NT-pro-BNP levels were strongly associated with adverse clinical events during pregnancy. Its early determination could be a successful tool in high risk pregnancy diagnosis, even for post-delivery events.