Competing risks model in screening for preeclampsia by maternal factors and biomarkers at 11-13 weeks gestation

Abstract

Combination of maternal factors and biomarkers provides effective first-trimester screening for preterm-preeclampsia.

Angiogenic Factors in Preeclampsia

“…82 The same group more recently confirmed that maternal factors when combined with PlGF levels and uterine artery pulsatility index can detect 75% of cases of preterm preeclampsia in a study of >35,000 patients. 83 Circulating angiogenic factors measured during early gestation have a high negative predictive value in ruling out the development of severe adverse maternal and perinatal outcomes among patients with systemic lupus erythematosus or antiphospholipid antibody syndrome. 84 In a prospective multicenter study, we demonstrated that among high-risk subjects with systemic lupus erythematosus or antiphospholipid antibody syndrome, the combination of sFlt1 and PlGF was most predictive of severe adverse pregnancy outcomes when measured early in pregnancy (16-19 weeks), with risk greatest for subjects with both PlGF in lowest quartile (<70.3 pg/mL) and sFlt1 in highest quartile (>1872 pg/mL; odds ratio, 31.1; 95% confidence interval, 8.0-121.9; positive predictive value, 58%; negative predictive value, 95%).…”

Aspirin for Evidence-Based Preeclampsia Prevention trial: effect of aspirin on length of stay in the neonatal intensive care unit

“…[13][14][15][16] A combination of maternal demographic characteristics and medical history with measurements of mean arterial pressure (MAP), uterine artery pulsatility index (UTPI) and serum placental growth factor (PLGF) at 11-13 weeks' gestation can identify about 75% of women that develop preterm-PE with delivery at <37 weeks' gestation and 90% of those with early-PE with delivery at <32 weeks, at a screen positive rate of 10%. 16 Several randomized studies investigated the possibility of preventing PE by the prophylactic use of aspirin and reported contradictory results. [17][18][19][20] Recent meta-analyses reported that aspirin reduces the risk of PE by >60%, provided the daily dose of the drug is >100 mg, the gestational age at onset of therapy is <16 weeks and the outcome measure is preterm-PE rather than total PE.…”

Prognostic Significance of Preterm Isolated Decreased Fetal Movement

“…Placental insufficiency and related pathologies generally begin at the start or at some point during the pregnancy and only presents clinically at a later stage. Many mathematical models have been developed for the prediction of preeclampsia, SGA and other pathological conditions associated with placental insufficiency (19). Biomarkers, ultrasonographic markers and maternal characteristics are used to predict these conditions (20).…”