Prediction of early, intermediate and late pre‐eclampsia from maternal factors, biophysical and biochemical markers at 11–13 weeks

Akolekar, Ranjit; Syngelaki, Argyro; Sarquis, Rita; Zvâncă, Mona Elena; Nicolaides, Kypros H.

doi:10.1002/pd.2660

Cited by 401 publications

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“…One article was omitted as two studies were based on the same population and presented similar data, [16,27] with the article reporting more complete information included. [16] Characteristics of the eight included studies are presented in Table 3.…”

Section: Systematic Review and Meta-analysismentioning

confidence: 99%

First trimester screening of maternal placental protein 13 for predicting preeclampsia and small for gestational age: In-house study and systematic review

et al. 2012

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Objective: To describe normative levels of PP13 in first-trimester of pregnancy and determine the accuracy of PP13 in predicting preeclampsia and small for gestational age (SGA) infants.Methods: We measured PP13 in archived first trimester serum samples from an unselected maternal cohort of 2,989 women. Associations of PP13 levels and diagnostic accuracy in predicting adverse pregnancy outcomes were assessed using multivariate logistic regression models. Due to inadequate number of cases we then conducted a systematic review involving structured search of electronic databases and subsequent meta-analysis of predictive accuracy using data from similar studies.Results: Overall, 2,678 women were included in the in-house study with 71 (2.7%) preeclampsia cases, 5 (0.2%) early-onset preeclampsia (≤34 weeks) cases; and 191 (7.1%) and 41 (1.5%) infants SGA<10 th and <3 rd centile. Median (IQR) normative level of PP13 in unaffected pregnancies was 53.5 (37.7-71.8) pg/ml. The area under the receiver operating characteristic curve (AUC) for multivariate models was 0.72 (95%CI 0.66-0.78) for preeclampsia; 0.82 (95%CI 0.63-0.99) for early-onset preeclampsia; 0.73 (95%CI 0.69-0.77) for SGA<10 th centile; and 0.83 (95%CI 0.78-0.88) for SGA<3 rd centile. Eight studies were included in the systematic review, normative levels of PP13 was assessed in four studies but these were variable; and meta-analysis was performed on seven studies. Sensitivity rates of PP13 based on 5% fixed false positive rates were 24%, 45% and 26% for preeclampsia, for early-onset preeclampsia and SGA, respectively.Conclusions: First-trimester PP13, in combination with maternal characteristics and other serum biomarkers was inadequate for screening purposes and predicting women at risk.

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Section: Systematic Review and Meta-analysismentioning

confidence: 99%

First trimester screening of maternal placental protein 13 for predicting preeclampsia and small for gestational age: In-house study and systematic review

et al. 2012

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“…Consequently, the measured concentrations of PAPP-A and PlGF must be adjusted for these variables before comparing results with pathological pregnancies. The MoM values of PAPP-A and PlGF are significantly reduced at 11-13 weeks' gestation in women who subsequently develop PE [3,18].…”

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confidence: 95%

“…A large number of biochemical markers have been investigated for a prediction of PE. Several biochemical markers (PAPP-A, PlGF, PP13, Sendoglin, Inhibin-A, Activin-A, Pentraxin 3 and P-Selectin) as potential predictors describe the foetal and placental endocrine functions and the maternal endothelial dysfunction [18]. Some studies are concluding that the major phenotype of PE, hypertension and proteinuria, may be due to an excess of circulating anti-antigenic growth factors, most notably soluble fms-like tyrosine kinase 1 (SFLT1) and soluble endoglin (SENG), and reduced levels of placental growth factor (PlGF) [19].…”

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confidence: 99%

Clinical and Biochemical Markers for Prediction of Preeclampsia

Jašović-Siveska¹

2017

OGIJ

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Submit Manuscript | http://medcraveonline.com disturbed liver function, renal failure and cerebral ischemia. PE is characterized by vasospasm, increased peripheral vascular resistance, and thus reduced organ perfusion [8].Pregnancy per se is a state of oxidative stress arising from the increased metabolic activity in placenta mitochondria and the reduced scavenging power of antioxidants [9]. The aetiology of PE is still not completely understood, although many facts of the disease have been illuminated. Endothelial cell dysfunction would seem to be the common denominator in the various stages of PE and appears to be present from the first trimester of pregnancy [10,11].Prediction and prevention of PE is a very important contribution for maternal health. The only guaranteed primary prevention of PE is avoidance of pregnancy; there are identified risk factors (maternal age, interval between pregnancies and maternal weight). Prevention of PE demands knowledge of the pathophysiological mechanism. Availability of techniques for early detection and intervention in the pathophysiological process are necessary. Finally, prevention of PE is a proper antenatal care which provides screening for hypertension and proteinuria, making intervention, such as timely delivers possible. With an organised antenatal care, such as found in most high in-come countries, the maternal mortality and serious morbidity have decreased.First step in prediction and prevention of PE is detection of women's level of risk for PE, based on factors in her history. Major risk factors for PE are: nuliparity, maternal age >40, prior PE, anti phospholipid antibody syndrome, family history of pe in first-degree relative, renal disease, chronic hypertension, diabetes mellitus, multiple gestations, strong family history of cv disease (heart disease or stroke in ≥2 first-degree relatives), obesity etc [1,3,12]. The maternal demographic characteristics, including medical and obstetric history, are potentially useful in screening for PE, but only when the various factors are incorporated into a combined algorithm derived by multivariate analysis [3].Blood pressure measurement is a screening test routinely used in antenatal care to detect or predict a hypertensive disease. Studies investigating the predictive accuracy of blood pressure measurement report conflicting results. In the period within 20 week of gestation the values of MAP over 85-90 mmHg and values of DBP over 75mmHg are an important predictive indicator for determination of the risk of hypertensive disorders in pregnancy, especially PE [13]. Regarding these conflicting reports, it is uncertain whether blood pressure measurement should be used routinely as a predictive test or should only be used to diagnose hypertensive disorders in pregnancy once they are suspected [14,15].Normal placentation is a process that starts in the first trimester and is more or less completed at the end of the second trimester. In PE, defective invasion of the spiral arteries by cytotrophoblast cells is associated with ...

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“…It has also been shown that the risk for numerous pregnancy complications can be assessed around 12+ weeks of gestation. Screening for pre-eclampsia is of particular importance, as its prevalence of between 1 and 2% justifies screening, and as the individual risk for pre-eclampsia can be reduced through the administration of aspirin to patients with an increased risk [2,17]. The screening study of Akolekar et al, the most comprehensive study to date, investigated around 33 000 normal pregnancies and 752 pregnancies with subsequent pre-eclampsia in 11+ to 13+ weeks of gestation [17,39].…”

Section: Studymentioning

confidence: 99%

“…Screening for pre-eclampsia is of particular importance, as its prevalence of between 1 and 2% justifies screening, and as the individual risk for pre-eclampsia can be reduced through the administration of aspirin to patients with an increased risk [2,17]. The screening study of Akolekar et al, the most comprehensive study to date, investigated around 33 000 normal pregnancies and 752 pregnancies with subsequent pre-eclampsia in 11+ to 13+ weeks of gestation [17,39]. They found that a screening policy that was based on the combination of previous maternal history, maternal blood pressure, resistance in the uterine arteries, and the serum markers PAPP-A and PlGF provided detection rates of more than 85% of those pregnancies that resulted in pre-eclampsia prior to 34 weeks of gestation, with a false positive rate of 10%.…”

Section: Studymentioning

confidence: 99%

Assessment of Foetal DNA in Maternal Blood – A Useful Tool in the Hands of Prenatal Specialists

Kagan

Hoopmann

Kozlowski³

2012

Geburtsh Frauenheilk

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Introduction !In the last few years, first trimester screening (FTS) in 11+ to 13+ weeks of gestation (12th to 14th weeks of gestation) has become one of the most important ultrasound examinations in pregnancy, as it allows physicians to predict several pregnancy complications [1]. While, initially, the main focus was to determine the personal risk for trisomies 21, 18 and 13, today around half of all severe foetal defects can be recognised at the time of FTS. In addition, the risks for pre-eclampsia, growth retardation and pre-term birth can be determined. Various interventions and therapies are now available to treat many of these problems in patients considered at particular risk [2,38]. The use of foetal DNA obtained from maternal blood and massively parallel sequencing has made it possible to detect foetal trisomy 21 with a high degree of probability already in the first trimester of pregnancy [3]. At a casual glance it would appear that use of foetal DNA to assess the risk for trisomy 21 now competes with FTS. But on more careful examination of these tests it becomes clear that assessment of foetal DNA has the potential to become an important tool for prenatal medicine specialists in future. This review offers an assessment of foetal DNA analysis in the context of current prenatal medical questions and demonstrates the practical uses of this approach. Assessment of Free Foetal DNA from Maternal Blood !The detection of foetal DNA in maternal blood or, to be more precise, in cell-free maternal plasma goes back to a study by Lo et al. published in 1997 [4]. Pregnancy-specific cell-free DNA in maternal blood or plasma constitutes around 10 % of all cell-free DNA, is largely fragmented and is not Abstract ! Over the last few years, first trimester screening between 11+ and 13+ weeks of gestation has become one of the most important ultrasound examinations in pregnancy, as it allows physicians to predict several pregnancy complications including pre-eclampsia or pre-term birth. Screening for trisomies 21/18 and 13 using maternal and gestational age, foetal nuchal translucency, and maternal serum biochemistry was formerly the main reason for first trimester screening. However, today this is only one part of the overall examination. In the near future, the analysis of foetal DNA obtained from maternal blood will be used to supplement first trimester screening for aneuploidy or even replace current screening methods. In this review we show how prenatal medicine specialists can use foetal DNA analysis. Zusammenfassung !Das Ersttrimesterscreening in der 11 + bis 13 + SSW hat sich in den vergangenen Jahren zu einer der zentralen Ultraschalluntersuchungen in der Schwangerschaft entwickelt, welche die Prädik-tion zahlreicher Probleme in der Schwangerschaft, wie Präeklampsie oder Frühgeburtlichkeit, erlaubt. Die eigentliche Risikoberechnung für Trisomie 21/18 und 13, basierend auf dem mütter-lichen Altersrisiko, der fetalen Nackentransparenz und der maternalen Serumbiochemie, stellt dabei nur einen der Schwerpunkte dar,...

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Prediction of early, intermediate and late pre‐eclampsia from maternal factors, biophysical and biochemical markers at 11–13 weeks

Cited by 401 publications

References 40 publications

First trimester screening of maternal placental protein 13 for predicting preeclampsia and small for gestational age: In-house study and systematic review

First trimester screening of maternal placental protein 13 for predicting preeclampsia and small for gestational age: In-house study and systematic review

Clinical and Biochemical Markers for Prediction of Preeclampsia

Assessment of Foetal DNA in Maternal Blood – A Useful Tool in the Hands of Prenatal Specialists

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