First-trimester screening for early and late preeclampsia using maternal characteristics, biomarkers, and estimated placental volume

Sonek, Jiri; Krantz, David; Carmichael, Jon; Downing, Cathy; Jessup, Karen; Haidar, Ziad A.; Ho, Shannon; Hallahan, Terrence; Kliman, Harvey J.; McKenna, David S.

doi:10.1016/j.ajog.2017.10.024

Cited by 84 publications

(77 citation statements)

References 54 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…9e11 In a recently published study performed on a population with a 4 times higher incidence of early preeclampsia (1.22%), the authors obtained a detection rate of 85% for both 5% and 10% false-positive rates. 22 But the results of this study may be skewed by the small sample size and the high prevalence of chronic hypertension in the studied population.…”

Section: Principal Findingsmentioning

confidence: 82%

A new model for screening for early-onset preeclampsia

Serra

Mendoza

Scazzocchio

et al. 2020

American Journal of Obstetrics and Gynecology

110

View full text Add to dashboard Cite

BACKGROUND: Early identification of women with an increased risk for preeclampsia is of utmost importance to minimize adverse perinatal events. Models developed until now (mainly multiparametric algorithms) are thought to be overfitted to the derivation population, which may affect their reliability when applied to other populations. Options allowing adaptation to a variety of populations are needed. OBJECTIVE: The objective of the study was to assess the performance of a first-trimester multivariate Gaussian distribution model including maternal characteristics and biophysical/biochemical parameters for screening of early-onset preeclampsia (delivery <34 weeks of gestation) in a routine care low-risk setting. STUDY DESIGN: Early-onset preeclampsia screening was undertaken in a prospective cohort of singleton pregnancies undergoing routine first-trimester screening (8 weeks 0/7 days to 13 weeks 6/7 days of gestation), mainly using a 2-step scheme, at 2 hospitals from March 2014 to September 2017. A multivariate Gaussian distribution model including maternal characteristics (a priori risk), serum pregnancy-associated plasma protein-A and placental growth factor assessed at 8 weeks 0/7 days to 13 weeks 6/7 days and mean arterial pressure and uterine artery pulsatility index measured at 11.0e13.6 weeks was used.RESULTS: A total of 7908 pregnancies underwent examination, of which 6893 were included in the analysis. Incidence of global preeclampsia was 2.3% (n ¼ 161), while of early-onset preeclampsia was 0.2% (n ¼ 17). The combination of maternal characteristics, biophysical parameters, and placental growth factor showed the best detection rate, which was 59% for a 5% false-positive rate and 94% for a 10% falsepositive rate (area under the curve, 0.96, 95% confidence interval, 0.94e0.98). The addition of placental growth factor to biophysical markers significantly improved the detection rate from 59% to 94%. CONCLUSION: The multivariate Gaussian distribution model including maternal factors, early placental growth factor determination (at 8 weeks 0/7 days to 13 weeks 6/7 days), and biophysical variables (mean arterial pressure and uterine artery pulsatility index) at 11 weeks 0/7 days to 13 weeks 6/7 days is a feasible tool for early-onset preeclampsia screening in the routine care setting. Performance of this model should be compared with predicting models based on regression analysis.

show abstract

Section: Principal Findingsmentioning

confidence: 82%

A new model for screening for early-onset preeclampsia

Serra

Mendoza

Scazzocchio

et al. 2020

American Journal of Obstetrics and Gynecology

110

View full text Add to dashboard Cite

show abstract

“…3 These risk factors have been already associated with various biomarkers, including pregnancy-associated plasma protein-A (PAPP-A), placental growth factor (PLGF) and maternal serum alpha-fetoprotein (AFP) in an effort to produce accurate predictive models and introduce preventive treatment. [4][5][6] Serum cancer antigen 125 (CA-125), also known as mucin 16 (MUC16) is a protein that belongs to the mucin family of glycoproteins and is expressed by epithelia as a response to infectious agents and foreign particles. 7 As a biomarker it is mainly used to diagnose endometriosis and ovarian cancer as well as during the follow-up period of patients treated for ovarian cancer.…”

mentioning

confidence: 99%

Serum CA‐125 levels in preeclampsia: A systematic review and meta‐analysis

et al. 2019

View full text Add to dashboard Cite

Background Preeclampsia is a leading cause of perinatal morbidity, although an optimal screening model is still under investigation. The aim of the present meta‐analysis is to accumulate current evidence and evaluate the diagnostic accuracy of CA‐125 in preeclampsia. Materials and Methods Medline, Scopus, CENTRAL, Clinicaltrials.gov and Google Scholar were systematically searched. All studies reporting serum CA‐125 among preeclamptic and healthy pregnant women were selected. Results Nine studies involving 977 women were included. Meta‐analysis revealed significant differences among patients with preeclampsia and control pregnant women (MD 15.86 IU/mL, 95% CI, 9.03‐22.69). Patients with severe preeclampsia had significantly higher levels of CA‐125 compared to patients with mild preeclampsia (MD 13.21 IU/mL, 95% CI, 1.94‐24.49). Meta‐regression analysis revealed that gestational age <34 weeks could positively affect this association. Conclusions The present meta‐analysis suggests that serum CA‐125 levels are increased in preeclamptic women during the third trimester of pregnancy. This association should be interpreted with caution as there are concerns for significant selection bias. Future studies are needed to corroborate these findings and investigate the diagnostic accuracy of this biomarker during early pregnancy.

show abstract

“…Specifically, two Spanish cohort studies developed models that included maternal risk factors, uterine artery PI, MAP, and biochemical markers reported similar predictive performance with that derived from the FMF test 63,64 . In contrast, three combined PE prediction algorithms based on cohort studies in American populations demonstrated lower predictive performance than that from the FMF test [65][66][67] .…”

Section: Pre-eclampsia Prediction Algorithmsmentioning

confidence: 76%

“…Measurement of biomarkers can be performed in the same setting for routine screening of common trisomies. The first trimester combined test can identify a high proportion of women that will develop preterm PE, but the performance of screening for term PE is suboptimal 21,46,55,59,60,[63][64][65][66][67][71][72][73]75,[80][81][82]85,[123][124][125][126][127][128] . The first trimester combined test is clinically useful because prophylactic low-dose aspirin (150 mg starting at <16 weeks, nightly) is effective in preventing preterm PE rather than term PE.…”

Section: Resultsmentioning

confidence: 99%

Screening and prevention of pre-eclampsia: a review

2019

Hong Kong J Gynaecol Obstet Midwifery

View full text Add to dashboard Cite

Pre-eclampsia (PE) is a major cause of maternal and perinatal morbidity and mortality. Early-onset PE requiring preterm delivery is associated with a higher risk of complications in both mothers and babies. It is important to identify pregnant women who are at high risk of developing PE in the first trimester, so that preventive measures can be initiated early to improve placentation and reduce the prevalence and severity of the disorder. This review illustrates that effective screening for early-onset PE can be performed in the first trimester of pregnancy by a combination of maternal risk factors, mean arterial pressure, uterine artery Doppler ultrasonography, and placental growth factor. This prediction algorithm has detection rates of 90%, 75%, and 41% for very-early (delivery <32 weeks), preterm (delivery <37 weeks), and term (delivery ≥37 weeks) PE at 10% false positive rate, respectively. This model has been validated in several populations. Recent evidence has demonstrated that administration of low-dose aspirin (150 mg/nightly) starting at 11-14 weeks of gestation to high-risk women is effective in reducing the risk of preterm PE and the length of stay in neonatal intensive care unit.

show abstract

First-trimester screening for early and late preeclampsia using maternal characteristics, biomarkers, and estimated placental volume

Cited by 84 publications

References 54 publications

A new model for screening for early-onset preeclampsia

A new model for screening for early-onset preeclampsia

Serum CA‐125 levels in preeclampsia: A systematic review and meta‐analysis

Screening and prevention of pre-eclampsia: a review

Contact Info

Product

Resources

About