First trimester screening for early and late preeclampsia based on maternal characteristics, biophysical parameters, and angiogenic factors. (19th November 2014)

• Record Type: Journal Article
• Authors: Crovetto, Francesca; Figueras, Francesc; Triunfo, Stefania; Crispi, Fatima; Rodriguez‐Sureda, Victor; Dominguez, Carmen; Llurba, Elisa; Gratacós, Eduard
• Is Part Of: Prenatal diagnosis. Volume 35:Number 2(2015:Feb.)
• Page Start: 183
• Page End: 191
• Publication Date: 2014-11-19
• Subjects: Prenatal diagnosis -- Periodicals; Fetus -- Diseases -- Diagnosis -- Periodicals; Electronic journals; 618.32075
• DOI: 10.1002/pd.4519
• Languages: English
• ISSNs: 0197-3851

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="pd4519-sec-0001" sec-type="section"> <title>Objective</title> <p>The aim of this article is to develop the best first‐trimester screening model for preeclampsia (PE) based on maternal characteristics, biophysical parameters, and angiogenic factors in a low‐risk population.</p> </sec> <sec id="pd4519-sec-0002" sec-type="section"> <title>Methods</title> <p>A prospective cohort of 9462 pregnancies undergoing first‐trimester screening is used. Logistic regression predictive models were developed for early and late PE (cut‐off of 34 weeks' gestation at delivery). Data included the <italic>a priori</italic> risk (maternal characteristics), mean arterial pressure (MAP), and uterine artery (UtA) Doppler (11–13 weeks) in all cases. Plasma levels (8–11 weeks) of human chorionic gonadotrophin, pregnancy‐associated plasma protein A, placental growth factor (PlGF), and soluble Fms‐like tyrosine kinase‐1 (sFlt‐1) were analyzed using a nested case–control study design.</p> </sec> <sec id="pd4519-sec-0003" sec-type="section"> <title>Results</title> <p>The best model for early PE (<italic>n</italic> = 57, 0.6%) included <italic>a priori</italic> risk, MAP, UtA Doppler, PlGF, and sFlt‐1 achieving detection rates of 87.7% and 91.2% for 5% and 10% false‐positive rates, respectively (AUC: 0.98 [95% CI: 0.97–0.99]). For late PE (<italic>n</italic> = 246, 2.6%), the best model included the <italic>a priori</italic> risk, MAP, UtA Doppler, PlGF, and sFlt‐1 achieving detection rates of 68.3% and 76.4% at 5% and 10% of false‐positive rates, respectively (AUC: 0.87 [95% CI: 0.84–0.90]).</p> </sec> <sec id="pd4519-sec-0004" sec-type="section"> <title>Conclusion</title> <p>Preeclampsia can be predicted with high accuracy in general obstetric populations with a low risk for PE, by combined algorithms. Angiogenic factors substantially improved the prediction. © 2014 John Wiley & Sons, Ltd.</p> </sec> </abstract>