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Published on: June 29, 2013
First trimester screening for intra-uterine growth restriction and early-onset pre-eclampsia
G Vandenberghe1, I Mensink, J W R Twisk
1Department of Obstetrics & Gynecology, VU University Medical Center, Amsterdam, the Netherlands. griet.vandenberghe@uzgent.be
Insights
First-trimester placental growth factor (PlGF) effectively screens for early-onset pre-eclampsia, but not for intra-uterine growth restriction. Pregnancy-associated plasma protein-A (PAPP-A) showed poor screening performance for both conditions.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Biomarker Discovery
Background:
- Early detection of adverse pregnancy outcomes like early-onset pre-eclampsia (PE) and intra-uterine growth restriction (IUGR) is crucial for timely intervention.
- First-trimester screening offers a window for identifying high-risk pregnancies.
Purpose of the Study:
- To evaluate placental growth factor (PlGF) and pregnancy-associated plasma protein-A (PAPP-A) as first-trimester screening markers for early-onset PE and IUGR.
Main Methods:
- Retrospective analysis of first-trimester serum samples from early-onset PE, IUGR cases, and controls.
- Measurement of PlGF and PAPP-A levels, adjusted for gestational age, ethnicity, and smoking (MoM).
- Logistic regression analysis to assess predictive capabilities of PlGF, PAPP-A, and maternal characteristics.
Main Results:
- Significantly lower PlGF multiples of the expected median (MoM) were observed in early-onset PE but not in IUGR.
- Significantly lower PAPP-A MoM levels were found in IUGR but not in early-onset PE.
- PlGF improved the prediction of early-onset PE when combined with first prenatal visit systolic blood pressure (AUC=0.8).
Conclusions:
- Serum PlGF is a viable first-trimester screening marker for early-onset PE.
- Serum PlGF demonstrates limited utility in screening for IUGR.
- Serum PAPP-A exhibits poor screening performance for both early-onset PE and IUGR.
Objective:
To assess first trimester placental growth factor (PlGF) and pregnancy-associated plasma protein-A (PAPP-A) as screening markers for early-onset pre-eclampsia (PE) and intra-uterine growth restriction (IUGR).
Methods:
PlGF concentration was retrospectively measured in first trimester serum specimens of 23 cases of early-onset PE (<34 weeks), 26 cases of IUGR (birth weight < 5th centile) and 5 controls per case. Levels were adjusted for gestational age (GA), ethnicity and smoking to obtain multiples of the expected median (MoM). Logistic regression was used to assess PlGF, PAPP-A and maternal characteristics as potential predictors of early-onset PE and IUGR.
Results:
PlGF MoM levels were significantly lower in the early-onset PE group (P < 0.0001) compared with controls, but not in the IUGR group. PAPP-A MoM levels were significantly lower in the IUGR group (P < 0.01) compared with controls but not in the early-onset PE group. PlGF significantly improved the ability of systolic blood pressure at the first prenatal visit to predict early-onset PE [achieving a receiver-operating characteristics curve with area under the curve (AUC) of 0.8]. Combining systolic blood pressure at the first prenatal visit and PlGF did not significantly improve the predictive ability compared with PlGF alone (AUC = 0.83).
Conclusion:
Serum PlGF is an acceptable marker in first trimester screening for early-onset PE, but a poor marker in screening for IUGR. Screening performance of serum PAPP-A is poor for both early-onset PE and IUGR.
