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Screening for pre-eclampsia at 35-37 weeks' gestation.

A Panaitescu¹, A Ciobanu¹, A Syngelaki¹

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

|June 14, 2018

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Screening for pre-eclampsia (PE) using maternal factors and biomarkers like placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) between 35-37 weeks gestation is effective. Performance varies by maternal racial origin.

Area of Science:

Maternal-fetal medicine
Pregnancy diagnostics
Biomarker research

Background:

Pre-eclampsia (PE) is a significant cause of maternal and fetal morbidity.
Effective screening for late-onset PE at 35-37 weeks gestation is crucial for timely intervention.
Current screening methods often lack sufficient predictive accuracy.

Purpose of the Study:

To evaluate the performance of screening for pre-eclampsia (PE) at 35-37 weeks gestation.
To assess the utility of maternal factors combined with biomarkers: mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI), serum placental growth factor (PlGF), and serum soluble fms-like tyrosine kinase-1 (sFlt-1).

Main Methods:

Prospective observational study of 13,350 singleton pregnancies.
Utilized Bayes' theorem to combine maternal characteristics with biomarker multiples of the median (MoM) values.

Keywords:

Bayes' theorem mean arterial pressure placental growth factor pre-eclampsia pyramid of pregnancy care soluble fms-like tyrosine kinase-1 survival model third-trimester screening uterine artery Doppler

Related Experiment Videos

Calculated patient-specific risks for delivery with PE.

Main Results:

Screening by maternal factors alone detected 28% of PE cases. Addition of MAP increased detection to 53%, MAP and PlGF to 67%, and MAP, PlGF, and sFlt-1 to 70%.
UtA-PI did not improve screening performance.
Screening performance varied by racial origin, with higher detection rates in Afro-Caribbean women (88%) compared to Caucasian women (66%) when using maternal factors, MAP, PlGF, and sFlt-1.

Conclusions:

Maternal factors combined with biomarkers (MAP, PlGF, sFlt-1) effectively screen for late-onset PE at 35-37 weeks gestation.
The performance of this screening strategy is influenced by the racial origin of the pregnant individual.
This approach can identify a significant proportion of pregnancies at high risk for developing PE.