Prediction of Adverse Maternal Outcomes in Preeclampsia

Dadelszen, Peter von; Payne, Beth; Li, J.; Ansermino, J. Mark; Pipkin, F. Broughton; Côté, Anne‐Marie; Douglas, M. Joanne; Gruslin, Andrée; Hutcheon, Jennifer A.; Joseph, K.S.; Kyle, Phillipa M.; Lee, T.; Loughna, Pamela; Menzies, Jennifer; Merialdi, Mario; Millman, Alexandra; Moore, Michael C.; Jm, Moutquin; Ouellet, Annie; Smith, Graeme N.; Walker, Julian; Walley, Keith R.; Walters, Barry N J; Widmer, Mariana; Lee, S.K.; Russell, James A.; Magee, Laura A.

doi:10.1097/01.aoa.0000410808.61878.a4

Cited by 25 publications

(26 citation statements)

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“…MPV MoM was however not significantly higher in women who later developed severe preeclampsia, suggesting platelet activation is not common to all cases of preeclampsia. Unlike previous reports (22) the ratio of platelet volume/number did not relate to development of preeclampsia (data not shown). The association of platelet volume with African American and Hispanic race, first-trimester BMI and systolic blood pressure indicates we may be identifying susceptible women with subclinical vascular dysfunction (23).…”

Section: Discussioncontrasting

confidence: 99%

First-Trimester Prediction of Preeclampsia in Nulliparous Women at Low Risk

Myatt

Clifton

Roberts

et al. 2012

Obstetrics & Gynecology

178

117

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Objective To identify clinical characteristics and biochemical markers in first-trimester samples that would possibly predict the subsequent development of preeclampsia. Methods We conducted a multicenter observational study in 2,434 low-risk nulliparous women to identify biomarkers that possibly predict preeclampsia. Clinical history, complete blood count, and biochemical markers were assessed in the first trimester. The trophoblast and angiogenesis markers ADAM-12 (a disintegrin and metalloprotease 12), pregnancy-associated plasma protein-A (PAPP-A), PP13, placental growth factor (PlGF), soluble fms-like tyrosine kinase-1, and endoglin were measured in a case-control subset of 174 women with preeclampsia and 509 controls. Results Univariable analysis revealed maternal age, race, marital status, years of education, source of medical payment, prenatal caregiver, body mass index (BMI), and systolic blood pressure at enrollment were significantly associated with preeclampsia. Mean platelet volume was greater at enrollment in women who later developed preeclampsia (median 9.4 vs 9.0fl, p=0.02). First-trimester concentrations (multiples of the median) of ADAM-12 (1.14 vs 1.04, p=0.003), PAPP-A (0.94 vs 0.98, p=0.04), and PlGF (0.83 vs 1.04, p<0.001) were significantly different in women who developed preeclampsia compared with controls. The optimal multivariable model included African American race, systolic blood pressure, BMI, education level, ADAM-12, PAPP-A and PlGF, and yielded an area under the curve of 0.73 (95% CI 0.69–0.77) and a sensitivity of 46.1% (95% CI 38.3–54.0) for 80% specificity. Conclusion A multivariable analysis of clinical data and biochemical markers in the first trimester did not identify a model that had clinical utility for predicting preeclampsia in a low-risk nulliparous population.

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Section: Discussioncontrasting

confidence: 99%

First-Trimester Prediction of Preeclampsia in Nulliparous Women at Low Risk

Myatt

Clifton

Roberts

et al. 2012

Obstetrics & Gynecology

178

117

View full text Add to dashboard Cite

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“…11 This study was much smaller than the current study, which may explain why only AST levels were identied as signicant.…”

Section: Discussioncontrasting

confidence: 54%

“…[6][7][8][9][10][11][12][13] Some authors suggest that analytes such as LDH, bilirubin, and possibly AST may prove to be more predictive because they reect multiple organ dysfunction. [9][10][11][12] The LDH level reects hemolytic cell damage and hepatic dysfunction, the bilirubin level reects both hemolysis and hepatic dysfunction, and the AST level reects tissue damage and hepatic dysfunction. The value of changes to these liver function tests over time in predicting adverse maternal outcomes has yet to be assessed in women with preeclampsia.…”

Section: Introductionmentioning

confidence: 99%

Abnormal Liver Function Tests as Predictors of Adverse Maternal Outcomes in Women With Preeclampsia

Kozic

Benton

Hutcheon

et al. 2011

Journal of Obstetrics and Gynaecology Canada

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Objectives: To evaluate whether (1) the absolute magnitude of liver function test values, (2) the percentage change in liver function test values over time, or (3) the rate of change in liver function test values over time predicts adverse maternal outcomes in women with preeclampsia Methods:We used data from the PIERS (Pre-eclampsia Integrated Estimate of RiSk) study, a prospective multicentre cohort study assessing predictors of adverse maternal outcomes in women with preeclampsia Women with at least one liver function test performed at the time of hospital admission were included Liver functions were tested by serum concentrations of aspartate amino transferase (AST), alanine amino transferase (ALT), lactate dehydrogenase (LDH), albumin, total bilirubin, and the international normalized prothrombin time ratio Parameters investigated were absolute levels, change within 48 hours of hospital admission, change from admission to delivery or outcome, and rate of change from admission to delivery or outcome of each liver function test The ability of these parameters to predict adverse outcomes was assessed using logistic regression analyses and by calculating the receiver operating characteristic (ROC) area under the curve (AUC)

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“…The underlying mechanism of preeclampsia and even pregnancy hypertension remains under debate and, until today there isn't any reliable biochemical marker available for an accurate prediction. Recently, some authors include the changes in several biochemical markers in a single model for preeclampsia prediction just about 75-80% of correct classification [11][12][13]. These results, besides indicating a potential predictive model, also reveal the usefulness of combined approaches instead of searching for a single biochemical marker.…”

Section: Introductionmentioning

confidence: 84%