Optimal first trimester preeclampsia prediction: a comparison of multimarker algorithm, risk profiles and their sequential application

Abstract

Objective To compare performance of multimarker algorithm, risk profiles and their sequential application in prediction of preeclampsia and determining potential intervention targets.Study Design Maternal characteristics, ultrasound variables and serum biomarkers were collected prospectively at first trimester. Univariate analysis identified preeclampsia associated variables followed by logistic regression analysis to determine the prediction rule. Combined characteristics of the cardiovascular, metabolic and the personal risk factors were compared to the multimarker algorithm and the sequential application of both methods.Results Out of 2433 women, 108 developed preeclampsia (4.4%). Probability scores considering nulliparity, prior preeclampsia, body mass index, diastolic blood pressure and placental growth factor had an area under the receiver operating characteristic curve 0.784 (95% CI = 0.721-0.847). While the multimarker algorithm had the lowest false negative rate, sequential application of cardiovascular and metabolic risk profiles in screen positives reduced false positives by 26% and identified blood pressure and metabolic risk in 49/54 (91%) women with subsequent preeclampsia as treatable risk factors.Conclusion Sequential application of a multimarker algorithm followed by determination of treatable risk factors in screen positive women is the optimal approach for first trimester preeclampsia prediction and identification of women that may benefit from targeted metabolic or cardiovascular treatment.

Pregnancy: An Underutilized Window of Opportunity to Improve Long-term Maternal and Infant Health—An Appeal for Continuous Family Care and Interdisciplinary Communication

“…Now, more complex first-trimester screening algorithms for PE and FGR offer individual risk prediction with up to 90 and 60% sensitivity, respectively (5, 92, 93); 91% of women that are test positive at the first-trimester screen have cardiovascular and metabolic conditions amenable to therapy (8). Since many of these risk profiles pre-date before or persist after pregnancy it appears that first-trimester screening for placental disease is not only cost-effective but could have therapeutic benefits that reach far beyond pregnancy (94).…”

“…Sentinel risk profiles need to be incorporated into care models, which will allow the initiation of personalized care paths for mothers and infants (8, 198). In the US, the diabetes prevention trial already aims to introduce a balanced diet and more active lifestyle to reduce later risks for diabetes (199).…”

“…More recently, it was recognized that adverse pregnancy outcome relating to placental syndromes is associated with maternal cardiovascular, metabolic, or thromboembolic risks and earlier mortality (Figure 1) (4). First-trimester screening algorithms now allow individualized prediction of fetal growth restriction (FGR), PE, spontaneous preterm birth (SPB), or GDM (5–8) by utilizing markers of pre-existing maternal “risk-profiles” that not only confer pregnancy-related risks but also lower the thresholds for disease in later life (4, 9, 10). …”

Fetal Hemodynamic Parameters in Low Risk Pregnancies: Doppler Velocimetry of Uterine, Umbilical, and Middle Cerebral Artery

“…Uterine arteries (UtA) assessment has been increasingly used as a screening method to predict the woman's risk of developing gestational diseases as preeclampsia [1, 11]. It is part of a multimarker algorithm for prediction of preeclampsia and determining potential intervention targets [11].…”

“…It is part of a multimarker algorithm for prediction of preeclampsia and determining potential intervention targets [11]. Elevated PI level, associated or not with early diastolic notch in the waveform, is associated with impaired uteroplacental perfusion and a higher risk of pregnancy complications as preeclampsia, fetal growth restriction (FGR), placental abruption, and adverse perinatal outcome [3, 5, 12].…”