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Screening for pre-eclampsia by maternal factors and biomarkers at 11-13 weeks' gestation
M Y Tan1,2, A Syngelaki1, L C Poon1,2
1King's College Hospital, London, UK.
Insights
Early screening for pre-eclampsia (PE) using maternal factors and biomarkers at 11-13 weeks gestation is effective. This method can identify a high proportion of pregnancies that develop early and preterm PE, aiding in timely intervention.
Area of Science:
- Maternal-fetal medicine
- Obstetrics
- Pregnancy screening
Background:
- Pre-eclampsia (PE) is a major cause of maternal and perinatal morbidity.
- Early detection of PE is crucial for timely intervention and improved outcomes.
- Current screening methods have limitations in predicting PE accurately.
Purpose of the Study:
- To evaluate the performance of screening for early, preterm, and term pre-eclampsia (PE) at 11-13 weeks' gestation.
- To assess the efficacy of using maternal factors, mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI), serum placental growth factor (PlGF), and serum pregnancy-associated plasma protein-A (PAPP-A) for PE screening.
Main Methods:
- Analysis of data from 61,174 singleton pregnancies screened at 11-13 weeks' gestation.
- Utilized Bayes' theorem to combine maternal characteristics with biomarker multiples of the median (MoM) values.
- Estimated the performance of screening for PE at <37 weeks' gestation.
Main Results:
- Combined screening using maternal factors, MAP, UtA-PI, and PlGF predicted 90% of early PE and 75% of preterm PE at a 10% screen-positive rate.
- PAPP-A inclusion did not enhance screening performance.
- Screening performance varied by racial origin, with higher detection rates in women of Afro-Caribbean descent.
Conclusions:
- Maternal factors and biomarkers at 11-13 weeks' gestation effectively screen for early and preterm PE.
- This screening approach can identify a significant proportion of high-risk pregnancies.
- Further research may refine screening protocols for diverse populations.
Objective:
To examine the performance of screening for early, preterm and term pre-eclampsia (PE) at 11-13 weeks' gestation by maternal factors and combinations of mean arterial pressure (MAP), uterine artery (UtA) pulsatility index (PI), serum placental growth factor (PlGF) and serum pregnancy-associated plasma protein-A (PAPP-A).
Methods:
The data for this study were derived from three previously reported prospective non-intervention screening studies at 11 + 0 to 13 + 6 weeks' gestation in a combined total of 61 174 singleton pregnancies, including 1770 (2.9%) that developed PE. Bayes' theorem was used to combine the prior distribution of gestational age at delivery with PE, obtained from maternal characteristics, with various combinations of biomarker multiples of the median (MoM) values to derive patient-specific risks of delivery with PE at < 37 weeks' gestation. The performance of such screening was estimated.
Results:
In pregnancies that developed PE, compared to those without PE, the MoM values of UtA-PI and MAP were increased and those of PAPP-A and PlGF were decreased, and the deviation from normal was greater for early than late PE for all four biomarkers. Combined screening by maternal factors, UtA-PI, MAP and PlGF predicted 90% of early PE, 75% of preterm PE and 41% of term PE, at a screen-positive rate of 10%; inclusion of PAPP-A did not improve the performance of screening. The performance of screening depended on the racial origin of the women; on screening by a combination of maternal factors, MAP, UtA-PI and PlGF and using a risk cut-off of 1 in 100 for PE at < 37 weeks in Caucasian women, the screen-positive rate was 10% and detection rates for early, preterm and term PE were 88%, 69% and 40%, respectively. With the same method of screening and risk cut-off in women of Afro-Caribbean racial origin, the screen-positive rate was 34% and detection rates for early, preterm and term PE were 100%, 92% and 75%, respectively.
Conclusion:
Screening by maternal factors and biomarkers at 11-13 weeks' gestation can identify a high proportion of pregnancies that develop early and preterm PE. © 2018 Crown copyright. Ultrasound in Obstetrics & Gynecology © 2018 ISUOG.
