Screening for pre‐eclampsia early in pregnancy: performance of a multivariable model combining clinical characteristics and biochemical markers. (1st September 2014)

• Record Type: Journal Article
• Authors: Giguère, Y; Massé, J; Thériault, S; Bujold, E; Lafond, J; Rousseau, F; Forest, J‐C
• Is Part Of: BJOG. Volume 122:Number 3(2015:Mar.)
• Page Start: 402
• Page End: 410
• Publication Date: 2014-09-01
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1111/1471-0528.13050
• Languages: English
• ISSNs: 1470-0328

Abstract

<abstract abstract-type="main" id="bjo13050-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bjo13050-sec-0001" sec-type="section"> <title>Objective</title> <p>To investigate the performance of a multivariable model combining <italic>a priori</italic> clinical characteristics and biomarkers to detect, early in pregnancy, women at higher risk of developing pre‐eclampsia (PE).</p> </sec> <sec id="bjo13050-sec-0002" sec-type="section"> <title>Design</title> <p>Nested case–control study.</p> </sec> <sec id="bjo13050-sec-0003" sec-type="section"> <title>Setting</title> <p>University medical centre, Quebec, Canada (CHU de Québec).</p> </sec> <sec id="bjo13050-sec-0004" sec-type="section"> <title>Population</title> <p>A total of 7929 pregnant women recruited between 10 and 18 weeks of gestation. In all, 350 developed hypertensive disorders of pregnancy (HDP)—of which 139 had PE, comprising 68 with severe PE and 47 with preterm PE—and were matched with two women with a normal pregnancy.</p> </sec> <sec id="bjo13050-sec-0005" sec-type="section"> <title>Methods</title> <p>We selected <italic>a priori</italic> clinical characteristics and promising markers to create multivariable logistic regression models: body mass index (BMI), mean arterial pressure (MAP), placental growth factor, soluble Fms‐like tyrosine kinase‐1, pregnancy‐associated plasma protein A and inhibin A.</p> </sec> <sec id="bjo13050-sec-0006" sec-type="section"> <title>Main outcome measures</title> <p>PE, severe PE, preterm PE, HDP.</p> </sec> <sec id="bjo13050-sec-0007" sec-type="section"> <title>Results</title> <p>At false‐positive rates of 5 and 10%, the estimated detection rates were between 15% (5–29%) and 32% (25–39%), and between 39% (19–59%) and 50% (34–66%), respectively. Considering the low prevalence of PE in this population, the positive predictive values were 7% (5–9%) to 10% (7–13%) for PE and 2% (1–4%) to 4% (3–6%) in the preterm and severe PE subgroups. The multivariable model yielded areas under the receiver operating characteristics curves (AUC) between 0.72 (0.61–0.81) and 0.78 (0.68–0.88). When only BMI and MAP were included in the model, the AUC were similar to those of the <italic>a priori</italic> model.</p> </sec> <sec id="bjo13050-sec-0008" sec-type="section"> <title>Conclusions</title> <p>In a population with a low prevalence of preterm PE, a multivariable risk algorithm using an <italic>a priori</italic> combination of clinical characteristics and biochemical markers did not reach a performance justifying clinical implementation as screening test early in pregnancy.</p> </sec> </abstract>