Evaluation of Maternal Serum ELABELA Levels in Pregnancies Diagnosed With Abortus Imminens Between 8 and 14 Weeks of Gestation.

AIM: Abortus imminens is a common condition in early pregnancy characterized by vaginal bleeding with a closed cervix and viable intrauterine pregnancy. Current biochemical markers have limited accuracy in predicting pregnancy outcomes. ELABELA (also known as Apela or Toddler), a peptide involved in angiogenesis and placental development, may serve as a potential biomarker in early pregnancy complications. This study aimed to evaluate maternal serum ELABELA levels in pregnancies diagnosed with abortus imminens. METHODS: This prospective cross-sectional study included 45 pregnant women diagnosed with abortus imminens between 8 and 14 weeks of gestation and 45 healthy controls. Maternal serum ELABELA levels were measured using enzyme-linked immunosorbent assay (ELISA). All serum samples were analyzed simultaneously in a single analytical batch to minimize interassay variability. Statistical analyses included group comparisons, receiver operating characteristic (ROC) curve analysis, and binary logistic regression. RESULTS: There were no significant differences between groups in terms of age, body mass index (BMI), gestational age at sampling, gravidity, or parity (p > 0.05). ELABELA levels were significantly lower in the abortus imminens group compared with controls (median: 649.82 vs. 859.60 pg/mL; p = 0.021). ROC analysis demonstrated modest discriminative ability (area under the curve [AUC] = 0.641; 95% confidence interval [CI]: 0.520-0.751), with an optimal cut-off value of 712.0 pg/mL (sensitivity 60.0%, specificity 68.9%). Logistic regression analysis showed no independent predictive value for ELABELA. CONCLUSION: Maternal serum ELABELA levels are significantly reduced in pregnancies with abortus imminens, suggesting a potential role in early placental dysfunction. Although ELABELA alone may not be a strong independent predictor, it may serve as a complementary biomarker in the evaluation of abortus imminens. Further large-scale prospective studies are needed to confirm these findings.