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Hypertensive disorders in pregnancy: screening by biophysical and biochemical markers at 11-13 weeks

L C Y Poon1, R Akolekar, R Lachmann

  • 1Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.

Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology
|March 17, 2010
PubMed

Insights

Screening for pre-eclampsia (PE) and gestational hypertension (GH) using maternal factors and biophysical markers at 11-13 weeks is effective. This combined approach accurately identifies women at high risk for these pregnancy complications.

Area of Science:

  • Maternal-fetal medicine
  • Obstetrics
  • Biochemistry

Background:

  • Hypertensive disorders in pregnancy, including pre-eclampsia (PE) and gestational hypertension (GH), pose significant risks to maternal and fetal well-being.
  • Early identification of at-risk pregnancies is crucial for timely intervention and improved outcomes.

Purpose of the Study:

  • To evaluate the performance of a combined screening strategy for PE and GH.
  • To assess the utility of maternal factors, biophysical markers (mean arterial pressure, uterine artery pulsatility index), and biochemical markers (placental growth factor, activin-A, P-selectin) in early pregnancy screening.

Main Methods:

  • A case-control study involving 26 early PE, 90 late PE, 85 GH cases, and 201 unaffected controls.
  • Maternal history, mean arterial pressure (MAP), and uterine artery lowest pulsatility index (L-PI) were measured.
  • Plasma and serum samples were analyzed for placental growth factor (PlGF), activin-A, and P-selectin, among other markers.

Main Results:

  • Multivariate analysis identified maternal factors, MAP, uterine artery L-PI, and PlGF as significant predictors for early PE.
  • Late PE prediction included maternal factors, MAP, uterine artery L-PI, PlGF, activin-A, and P-selectin.
  • For GH, maternal factors, MAP, uterine artery L-PI, and activin-A were significant predictors. Detection rates at 5% FPR were 88.5% for early PE, 46.7% for late PE, and 35.3% for GH.

Conclusions:

  • Combined screening using maternal factors, biophysical, and biochemical markers at 11-13 weeks' gestation effectively identifies women at high risk for hypertensive disorders.
  • This early screening approach holds promise for improving the management of PE and GH.
Abstract

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