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Disease Markers
Volume 35, Issue 5, Pages 497–503
Research Article

Activin A and Follistatin as Biomarkers for Ectopic Pregnancy and Missed Abortion

1Department of Obstetrics and Gynecology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Biopolis, Larissa, Greece
2Division of Pediatric—Adolescent Gynecology and Reconstructive Surgery, 2nd Department of Obstetrics and Gynecology, University of Athens, Medical School, Aretaieion Hospital, 11528 Athens, Greece
3Department of Microbiology Medical School, University of Athens, 11527 Athens, Greece
4Department of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, 41221 Larissa, Greece

Received 30 June 2013; Accepted 3 September 2013

Academic Editor: Irene Rebelo

Copyright © 2013 Alexandros Daponte et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Activin A as a predictor of pregnancy failure has been the focus of heated debate, but the value of a combined activin A and follistatin (FS) measurement in serum to predict pregnancy failure has not been reported yet. We assessed whether a single serum measurement of the two physiological antagonists at 6–8 weeks gestation could differentiate ectopic pregnancies (EP) or missed abortions (MA) from healthy intrauterine pregnancies (IUP). activin A concentrations were significantly lower in women with EP ( = 30, median value of 264 pg/mL) and women with MA ( = 30, median value of 350 pg/mL) compared to IUP ( = 33, median value of 788 pg/mL); . At a threshold value of 505 pg/mL, activin A had 87.9% sensitivity and 100% specificity and negative predictive value of 0.974 for discriminating an ectopic pregnancy from viable pregnancies. FS was able to discriminate IUP from EP (ROC curve ) as was their ratio (ROC curve ), but was unable to discriminate a MA from an EP. In EP, activin A did not correlate with beta HCG levels. The present findings support the thesis that activin A or FS could be considered promising biomarkers for the discrimination between an IUP and a failed pregnancy (MA or EP).