Results of a Five-Year Experience in First Trimester Preeclampsia Screening

Abstract

Background and Objectives: The study aimed to evaluate the ability defining the risk of developing preeclampsia by a screening test carried out in the first trimester (between 11 + 0 and 13 + 6 weeks of gestational age), in order to identify high-risk women requiring more intensive health surveillance. The secondary objective was to evaluate the ability of this test to predict the risk of adverse obstetric outcomes such as fetal growth restriction, intrauterine fetal death, gestational hypertension, HELLP syndrome, placental abruption, and preterm birth. Materials and Methods: This was a single-center study, conducted at the Operative Unit of Obstetrics of the State Hospital of the Republic of San Marino. Medical history was collected at the time of enrolment in writing. Subsequently, obstetric outcomes were collected for each enrolled woman, through the analysis of medical records. Results: From October 2014 to May 2019, 589 pregnant women were recruited, of whom, 474 (80.5%) were included in the “low-risk” group, and 115 (19.5%) in the “high-risk” group. At the time of analysis of this population, the obstetric outcomes were available for 498 women (84.5%), while 91 cases (15.5%) were current pregnancies. The PI of the uterine arteries was not significantly different between the two study groups. Otherwise, a significant difference was highlighted for MAP, which is higher in the case of pregnancies at high risk based on the risk factors only, and for PAPP-A, higher in the case of low-risk pregnancies. Regarding the percentage of fetal DNA, according to the most recent literature data, in our series, we report a statistically significant difference of the average between the low and high-risk groups. Conclusions: In our study, we demonstrate that the multiparametric screening test for early PE performed well in identifying women at high risk of early PE, which certainly has the most severe maternal–fetal outcomes. The data reported that ASA intake at low doses is significantly higher in the population with high-risk tests for both early PE and late PE suggest once again that anamnestic evaluation plays an essential role in women’s screening.

Pravastatin in preeclampsia: A meta-analysis and systematic review

“…Capriglione et al's study highlights that in the first-trimester screening of preeclampsia the PI of the uterine artery does not differ significantly in high and normal-risk pregnancies. However, their study found that MAP is significantly higher in high-risk pregnancies, in terms of preeclampsia (66).…”

First-Trimester Screening Tests and Perinatal Outcomes

“…Because IGFBP cannot be destroyed by PAPP-A deficiency, K. SUMAN, E. GÖK, M. BÜYÜK, M. SUMAN its level increases. The increase in IGFBP level binds more IGF-1 and IGF-2, and as free IGF decreases, this negatively affects fetal growth 3,11,12 . IGF controls the uptake of glucose and amino acids by trophoblasts and controls trophoblast invasion of the decidua in an autocrine and paracrine manner 13 .…”

“…Similarly, high HCG levels are associated with an increased incidence of gestational hypertension, preeclampsia, preterm delivery, and fetal loss 3 . High HCG and low PAPP-A levels may also be associated with some placental pathologies.…”

Predictive Performance of Machine Learning-Based Methods for the Prediction of Preeclampsia—A Prospective Study

“…A recent unicentric study on 498 patients, which evaluated the results from the first trimester screening of PE in a 5 years’ time frame, revealed that an algorithm based on risk factors from the maternal history, the serum level of PlGF and PAPP-A, the calculated value of MAP, and the measured values of the uterine arteries PI achieved a PPV for early PE of 21.3% [ 54 ]. We obtained higher PPV (range: 71.4–80%) for EO-PE prediction using the proposed machine learning-based methods, and these results could be due to the inclusion of PP-13 as a biomarker that has high sensitivity for EO-PE [ 55 ].…”