PURPOSE: Oxidative stress is involved in the pathogenesis of hypertensive 
disorders such as preeclampsia (PE) and associated with the human vitamin 
E-binding protein afamin. The aim of this study was, therefore, to analyse 
afamin in the first trimester of patients developing PE later in pregnancy and 
in control subjects without pregnancy complications.
METHODS: In this retrospective study, 137 serum samples from the first trimester 
of pregnancy were analysed in a case-control study design. 39 patients developed 
PE (10 patients with early-onset and 29 patients with late onset disease) and 98 
women had an uncomplicated pregnancy. Mann-Whitney U test, t test, logistic 
regression and ROC analyses were performed for statistical evaluation.
RESULTS: Pregnant women developing PE presented with higher afamin 
concentrations in the first trimester [median 101.81 mg/L; interquartile range 
(IQR) 88.94-113.26] compared to subjects with uncomplicated pregnancy (median 
86.40; IQR 75.26-96.92; p < 0.001). After adjusting for confounders, the odds 
ratio per afamin standard deviation was 1.60 (95% CI: 1.04-2.58; p = 0.04). An 
afamin threshold concentration of 87.8 mg/L exhibited the best sensitivity 
(79.5%) and specificity (57.1%) in predicting PE. Subgroup analysis of early- 
and late-onset disease resulted in substantially higher afamin concentrations in 
women with developing late-onset PE compared to controls (p < 0.001) with an 
odds ratio per afamin standard deviation of 1.62 (95% CI: 0.98-2.70; p = 0.06).
CONCLUSIONS: Serum afamin concentrations are elevated in the first trimester 
among patients developing PE compared to controls. Substantial differences were 
observed mainly among patients with late-onset PE.