First Trimester Aneuploidy Screening Program for Preeclampsia Prediction in a Portuguese Obstetric Population

Abstract

Objective. To evaluate the performance of a first trimester aneuploidy screening program for preeclampsia (PE) prediction in a Portuguese obstetric population, when performed under routine clinical conditions. Materials and Methods. Retrospective cohort study of 5672 pregnant women who underwent routine first trimester aneuploidy screening in a Portuguese university hospital from January 2009 to June 2013. Logistic regression-based predictive models were developed for prediction of PE based on maternal characteristics, crown-rump length (CRL), nuchal translucency thickness (NT), and maternal serum levels of pregnancy-associated plasma protein-A (PAPP-A) and free beta-subunit of human chorionic gonadotropin (free β-hCG). Results. At a false-positive rate of 5/10%, the detection rate for early-onset (EO-PE) and late-onset (LO-PE) PE was 31.4/45.7% and 29.5/35.2%, respectively. Although both forms of PE were associated with decreased PAPP-A, logistic regression analysis revealed significant contributions from maternal factors, free β-hCG, CRL, and NT, but not PAPP-A, for prediction of PE. Conclusion. Our findings support that both clinical forms of EO-PE and LO-PE can be predicted using a combination of maternal history and biomarkers assessed at first trimester aneuploidy screening. However, detection rates were modest, suggesting that models need to be improved with additional markers not included in the current aneuploidy screening programs.

Screening for preeclampsia in the first trimester of pregnancy in routine clinical practice in Hungary

“…This study demonstrated that screening for early-PE could be achieved in routine clinical practice in Eastern Europe at a DR of 72.7% when using maternal characteristics, biophysical measurements, and PAPP-A. Compared with the DRs of the FMF (89.2%) (Poon et al, 2009c), our DRs are lower and similar to some other studies (Oliveira et al, 2014, Teixeira et al, 2014, Cheng et al, 2018, Sepulveda-Martinez et al, 2019 performed under routine clinical practice rather than in research settings. Apart from performing this study under routine clinical practice, another explanation for the lower DRs is the relatively low number of early-PE cases.…”

Predictive Performance of Serum β-hCG MoM Levels for Preeclampsia Screening: A Meta-Analysis

“…After further evaluation, 124 studies were removed following a more detailed full-text assessment, including 47 studies that were not cohort or case-control studies, 19 studies that were unrelated to PE and 58 that were unrelated to b-hCG MoM. Finally, 21 casecontrol publications were selected for inclusion in this metaanalysis (12)(13)(14)(15)(16)(17)(18)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45). The enrolled studies were of moderate to high quality, and the NOS assessments for each included study are summarized in Table 1.…”

Predictive Value of Free β-hCG Multiple of the Median for Women with Preeclampsia

“…One additional study was removed after further assessment due to lack of integrity in data presentation. Finally, 12 case-control studies, published between 1998 and 2014, were selected for analysis in the current meta-analysis study [16,17,29,30,31,32,33,34,35,36,37,38]. The enrolled papers showed moderate to high quality, and CASP assessments for each included study are summarized in figure 2.…”

“…The sample size ranged between 14 and 4,799. Of the 12 studies, 9 were in Caucasian populations - Portugal (Teixeira [30]), UK (Lai et al [31], Suri et al [35], Luckas et al [33], Spencer et al [16]), The Netherlands (Wortelboer et al [38]), Finland (Tikkanen et al [36], Raty et al [34]) and Turkey (Ozdamar et al [29]) - and 3 studies were performed in Asian populations - China (Xu and Yu [17], Tsai et al [37], Lee et al [32]). Six different methods were used to measure serum β-hCG levels in the included studies: dissociation-enhanced lanthanide fluoroimmunoassay was used in 6 studies, enzyme-linked immunosorbent assay was used in 2 studies, and the other four remaining methods (ultrasonographic assessment, microparticle enzyme immunoassay, time-resolved fluorescence immunoassay and radioimmunoassay) were utilized in 4 separate studies.…”