Predicting the risk of pre‐eclampsia between 11 and 13 weeks' gestation by combining maternal characteristics and serum analytes, PAPP‐A and free β‐hCG

Abstract

Objective To determine if a simplified model for predicting pre-eclampsia can be developed by combining first trimester serum analytes, PAPP-A and free β-hCG, and maternal characteristics. Methods A retrospective cohort study of patients seen for first-trimester aneuploidy screening from 2003–2009. The 5th, 10th, 90th and 95th percentiles for the analyte-MoMs for our population were determined and evaluated for association with pre-eclampsia. Univariate and backward stepwise logistic regression analyses were performed and the area under the ROC curves (AUC) used to determine the best models for predicting pre-eclampsia. Results Among 4,020 women meeting the inclusion criteria, outcome data was available for 3,716 (93%). There were 293 cases of pre-eclampsia. The final model identified a history of pre-gestational diabetes (aOR 2.6, 95% CI 1.7–3.9), chronic hypertension (aOR 2.6, 95% CI 1.7–3.9), maternal BMI >25 (aOR 2.5, 95% CI 1.9–3.4), African American race (aOR 1.8, 95% CI 1.3–2.6), and PAPP-A MoM <10th percentile (aOR 1.6, 95% CI 1.1–2.4) to be significant predictors of pre-eclampsia. (AUC= 0.70, 95% CI 0.65–0.72) Conclusion Low first-trimester PAPP-A levels are associated with the development of pre-eclampsia; however, the model was only modestly efficient in its predictive ability.

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

“…Consistent with this, previous studies observed that risk stratification based on multiple of the median (MoM) values of serum β-hCG levels might be advantageous in high-risk pregnancies, especially noting that a high MoM of β-hCG levels is observed in patients with PE compared to normal pregnant women [16,17]. In contrast, several other studies could not verify this association between β-hCG levels and PE [18,19]. Therefore, we performed a meta-analysis to assess the potential value of MoM of β-hCG serum levels in predicting PE pathology.…”

Extracellular Nucleic Acids in Maternal Circulation as Potential Biomarkers for Placental Insufficiency

“…Using single biochemical markers usually has a low predictive value in the first trimester. PAPP-A, a glycoprotein synthesized in the placenta, has been shown to be a powerful predictive biochemical marker of PE when combined with Doppler ultrasound, reaching 70% sensitivity at 95% specificity (Spencer et al, 2008;Goetzinger et al, 2010;Anderson et al, 2011). However, some recent studies evaluating PAPP-A as a firsttrimester predictive marker for PE showed conflicting results that indicated no differentiation between complicated and uncomplicated pregnancies (Mikat et al, 2011;Stirnemann et al, 2011).…”

Prediction of the preeclampsia: a view of biochemical markers

“…But the screening performance is extremely low when used as a single biochemical marker and the predictive rate is only about 10-20 % [14]. Several studies denoted low first or second trimester serum PAPP-A value is predictive and diagnostic biochemical marker of preeclampsia [14][15][16][17][18][19][20][21][22][23]. First trimester serum PAPP-A is low also prior to other pregnancy complications, such as in pregnancies developing fetal growth restriction, spontaneous miscarriage placental abruption, preterm birth and stillbirth and gestational diabetes [15,16,20,23].…”

“…PAPP-A has been evaluated as a predictive and diagnostic biochemical marker for PE. But the screening performance is extremely low when used as a single biochemical marker and the predictive rate is only about 10-20 % [14]. Several studies denoted low first or second trimester serum PAPP-A value is predictive and diagnostic biochemical marker of preeclampsia [14][15][16][17][18][19][20][21][22][23].…”