Serum prostate-specific antigen concentrations during the first and third trimesters in uncomplicated pregnancies, preeclampsia and fetal growth restriction

Prostate-specific antigen (PSA) is a serine protease traditionally regarded as prostate-derived, yet subsequent research has demonstrated its presence in multiple non-prostatic tissues, including the placenta. Accumulating evidence suggests that PSA may participate in uterine tissue remodeling and be implicated in the pathogenesis of preeclampsia (PE) and fetal growth restriction (FGR). This study aimed to evaluate maternal serum PSA levels in the first and third trimesters and to assess their potential association with the development of PE and FGR. The study consisted of two cohorts. The first-trimester cohort included women undergoing routine prenatal screening at 11 + 0–13 + 6 weeks of gestation. PE risk assessment followed the Fetal Medicine Foundation protocol, including maternal characteristics, mean arterial pressure, uterine artery pulsatility index (UtA PI), and serum placental growth factor (PlGF). The third-trimester cohort included women admitted with a diagnosis of PE or FGR, and healthy pregnant volunteers as controls. Maternal blood samples were collected in both cohorts for PSA measurement. A total of 169 women were included in the first-trimester cohort. PSA was detectable in 139 (82.2%) participants, with a mean concentration of 0.039 ± 0.07 ng/ml. Serum PSA levels showed a significant positive correlation with UtA PI (rs = 0.18, p = 0.023). Women with detectable PSA had higher mean UtA PI(1.68 ± 0.49 vs. 1.47 ± 0.385, p = 0.025) and lower PlGF levels compared with those with non-detectable PSA (47,3 ± 19.98 vs. 62.2 ± 29.96 pg/ml, p = 0.007). The third-trimester cohort included 161 women: 27 with PE, 47 with FGR, and 87 controls. PSA was detectable in 62.9% of PE cases, 68.1% of FGR cases, and 52.9% of controls, with no statistically sigificant differences (p = 0.20). In multivariable GAM analysis, only gestational age emonstrated a statistically significant nonlinear association with log-PSA (edf = 7.0, p = 0.012). The presented study characterizes the pattern of serum PSA levels during the 1st and 3rd trimesters of pregnancy. In the 1st trimester statistical correlations between PSA and uterine artery hemodynamics are observed, however its clinical significance remains unclear. In the 3rd trimester maternal serum PSA cannot serve as a biomarker for PE and FGR. Further research is needed to improve our understanding of the role of PSA in early pregnancy and placental development.