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Circulating Nucleic Acids in Maternal Plasma and Serum in Pregnancy Complications: Are They Really Useful in Clinical Practice? A Systematic Review

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Abstract

Objective

A systematic review was carried out to summarize the available evidence to assess whether circulating nucleic acids in maternal plasma and serum (CNAPS) have the potential to serve as extra and independent markers for the prediction and/or progression monitoring of the most common and severe complications of pregnancy, including preeclampsia, intrauterine growth restriction, preterm delivery, morbidly adherent placenta, gestational diabetes, antiphospholipid syndrome, threatened abortion, intrahepatic cholestasis of pregnancy, and hyperemesis gravidarum.

Method

A comprehensive literature search of the MEDLINE (PubMed), EMBASE, and ISI Web of Knowledge databases was conducted to identify relevant studies that included amounts of CNAPS in the abovementioned pregnancy complications.

Results

Eighty-three studies met the eligibility criteria. The vast majority of studies were conducted on the quantity of total circulating cell free DNA (cfDNA) and cell free fetal DNA (cffDNA), and some were conducted on messenger RNA (mRNA) species. A few studies have instead evaluated the cell free DNA fetal fraction (cfDNAff), but only in a limited number of pregnancy complications. Despite the growing interest and the abundance of the papers available, little information is available for other new CNAPS, including microRNA (miRNA), long noncoding RNA (lncRNA), mitochondrial DNA (mtDNA), and circular RNA.

Conclusion

Due to the heterogeneity of the populations enrolled, the scarcity of the studies that adjusted the CNAPS values for possible confounding factors, and the difficulty in interpreting the published data, no conclusion regarding the statistical robustness and clinical relevance of the data can be made at present. If assayed at the third trimester, the CNAPS have, however, shown better performance, and could be used in populations already at risk of developing complications as suggested by the presence of other clinical features. Other CNAPS, including miRNA, are under investigation, especially for the screening of gestational diabetes mellitus, but no data about their clinical utility are available. Circulating DNA (cfDNA, cffDNA, and cfDNAff) and mRNA have not been properly evaluated yet, especially in patients asymptomatic early in pregnancy but who developed complications later, perhaps because of the high cost of these techniques and the availability of other predictors of pregnancy complications (biochemical, biophysical, and ultrasound markers). Therefore, from the analysis of the data, the positive predictive value is not available. As regards the new CNAPS, including miRNA, there are still no sufficient data to understand if they can be promising markers for pregnancy complications monitoring and screening, since CNAPS are statistically weak and expensive. It is reasonable to currently conclude that the use of the CNAPS in clinical practice is not recommended.

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Author notes

  1. Ilma Floriana Carbone and Alessandro Conforti contributed equally to this work.

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, ‘L. Mangiagalli’ Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy

    Ilma Floriana Carbone

  2. Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy

    Alessandro Conforti, Silvia Picarelli & Carlo Alviggi

  3. Istituto per l’Endocrinologia e l’Oncologia Sperimentale (IEOS), Consiglio Nazionale delle Ricerche, Naples, Italy

    Carlo Alviggi

  4. Department of Obstetrics and Gynecology, S. Anna University Hospital, Cona, Ferrara, Italy

    Danila Morano

  5. Division of Obstetrics and Prenatal Medicine, Department of Medicine and Surgery (DIMEC) Sant’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy

    Antonio Farina

  6. Division of Obstetrics and Gynecology, Department of Medicine and Surgery (DIMEC), University of Bologna, Policlinico Sant’Orsola- Malpighi, Bologna, Italy

    Antonio Farina

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  1. Ilma Floriana Carbone
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Correspondence to Antonio Farina.

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The authors, Ilma Floriana Carbone, Alessandro Conforti, Silvia Picarelli, Danila Morano, Carlo Alviggi, and Antonio Farina, do not have any conflict of interest.

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Carbone, I.F., Conforti, A., Picarelli, S. et al. Circulating Nucleic Acids in Maternal Plasma and Serum in Pregnancy Complications: Are They Really Useful in Clinical Practice? A Systematic Review. Mol Diagn Ther 24, 409–431 (2020). https://doi.org/10.1007/s40291-020-00468-5

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