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Published on: September 10, 2018
Combined screening for preeclampsia and small for gestational age at 11-13 weeks
Leona C Y Poon1, Argyro Syngelaki, Ranjit Akolekar
1Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
Insights
This study combined algorithms to effectively screen for preeclampsia (PE) and small for gestational age (SGA) in the first trimester. Early detection of PE and preterm-SGA is achievable with this integrated approach.
Area of Science:
- Maternal-fetal medicine
- Obstetrics
- Perinatal screening
Background:
- Preeclampsia (PE) and small for gestational age (SGA) are significant adverse pregnancy outcomes.
- Accurate first-trimester prediction of PE and SGA is crucial for timely intervention.
- Existing algorithms often focus on PE or SGA individually.
Purpose of the Study:
- To develop and evaluate a combined prediction algorithm for PE and SGA.
- To integrate an algorithm for SGA prediction with a previously established algorithm for early PE detection.
- To assess the performance of the combined algorithm in predicting both conditions.
Main Methods:
- A screening study of singleton pregnancies at 11-13 weeks gestation.
- Development of a prediction algorithm for preterm-SGA using maternal characteristics, ultrasound, and serum biomarkers (PAPP-A, PlGF).
- Evaluation of the SGA algorithm alone and in combination with an early-PE algorithm for predicting SGA and PE.
Main Results:
- The combined approach demonstrated effective first-trimester screening capabilities.
- Detection rates included 95.3% for early-PE, 45.6% for late-PE, 55.5% for preterm-SGA, and 44.3% for term-SGA.
- A false positive rate of 10.9% was observed with specific risk cutoffs.
Conclusions:
- Combined first-trimester screening for early-PE and preterm-SGA is effective.
- The integrated algorithm offers a valuable tool for improving perinatal outcomes.
- This approach facilitates early identification and management of high-risk pregnancies.
Objective:
To combine a specific algorithm for small for gestational age (SGA) without preeclampsia (PE) and another algorithm for PE in the prediction of SGA and PE.
Methods:
This was a screening study of singleton pregnancies at 11-13 weeks including 1,426 (2.3%) that subsequently developed PE, 3,168 (5.1%) that delivered SGA neonates and 57,458 that were unaffected by PE and SGA. We developed a prediction algorithm for SGA requiring delivery before 37 weeks' gestation (preterm-SGA) from maternal characteristics, uterine artery pulsatility index, mean arterial pressure, serum pregnancy-associated plasma protein-A and placental growth factor multiple of the median values. We then examined the performance of this algorithm individually and in combination with a previously reported algorithm for early-PE in the prediction of SGA and PE.
Results:
When screen positivity was defined by risk cutoff of 1:200 using the algorithm for early-PE and the risk cutoff of 1:150 using the algorithm for preterm-SGA, the false positive rate was 10.9% and the detection rates of early-PE, late-PE, preterm-SGA and term-SGA were 95.3, 45.6, 55.5 and 44.3%, respectively.
Conclusions:
Effective first-trimester screening for early-PE and preterm-SGA can be provided by the combined use of the specific algorithms.
