Comparison of preeclampsia and fetal growth restriction screenings at first trimester in a high-risk population
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Published on: June 29, 2013
Ximena Carolina Romero Infante1, Montserrat Uriel1, Alexandra Porras Ramírez2
1Universidad El Bosque, Ecodiagnóstico El Bosque S. A. S, Los Cobos Medical Center, El Bosque Research Group of Maternal Fetal Medicine and Gynecology, Bogotá, Colombia.
Insights
Combined screening using maternal characteristics, biophysical markers, and biochemical markers like placental growth factor (PlGF) and pregnancy-associated plasma protein-A (PAPP-A) significantly improves detection of preeclampsia and fetal growth restriction (FGR). This approach offers higher sensitivity and specificity for early identification in high-risk pregnancies.
Area of Science:
- Maternal-fetal medicine
- Reproductive endocrinology
- Clinical obstetrics
Background:
- Preeclampsia and fetal growth restriction (FGR) are major causes of maternal and perinatal morbidity.
- Early and accurate screening is crucial for timely intervention in high-risk pregnancies.
- Current screening methods have limitations in sensitivity and specificity.
Purpose of the Study:
- To compare the effectiveness of different screening strategies for preeclampsia and FGR.
- To evaluate the added value of biochemical markers to maternal characteristics and biophysical markers.
- To assess screening performance in a high-risk obstetric population.
Main Methods:
- Prospective study of 527 singleton pregnancies at 11-14 weeks' gestation.
- Evaluation of maternal characteristics, mean arterial blood pressure, and uterine artery pulsatility index.
- Inclusion of biochemical markers: placental growth factor (PlGF) and pregnancy-associated plasma protein-A (PAPP-A).
- Analysis using receiver operating characteristic (ROC) curves.
Main Results:
- Combined screening (maternal characteristics, biophysical, and biochemical markers) achieved 85.5% sensitivity and 96.3% specificity for preeclampsia.
- For FGR, combined screening demonstrated 67.2% sensitivity and 82.7% specificity.
- Screening with only maternal characteristics and biophysical markers showed lower performance for both conditions.
Conclusions:
- Combined screening at 11-14 weeks' gestation offers superior sensitivity and specificity for preeclampsia and FGR.
- Integrating maternal characteristics, mean blood pressure, uterine artery pulsatility index, PAPP-A, and PlGF is recommended.
- This comprehensive approach enhances the identification of high-risk pregnancies for preeclampsia and FGR.
Aim:
To compare the sensitivity and specificity of screening for preeclampsia and FGR including maternal characteristics, mean arterial blood pressure and uterine artery pulsatility index and the combined screening, which adds biochemical markers, such as placental growth factor (PlGF) and pregnancy-associated plasma protein-A (PAPP-A), in a sample of high risk population for hypertensive disorders.
Methods:
This is a prospective study with 527 singleton pregnancies at 11-14 weeks of gestation. Maternal characteristics, biochemical and biophysical markers were studied to determine the development of preeclampsia and FGR by using receiver operating characteristic curves.
Results:
For preeclampsia, screening, including sociodemographic data plus biophysical markers, had a sensitivity and specificity of 70.3% (CI% 64.3-75.2) and 93.8% (CI% 90.9-96.8), respectively. Combined screening, which includes sociodemographic data, biophysical (mean blood pressure and uterine artery pulsatility index) and biochemical markers (PlGF and PAPP-A), increased sensitivity and specificity up to 85.5% (CI% 80.2-90.3) and 96.3% (CI% 91.4-98.9), respectively. For FGR, sociodemographic data plus biophysical markers had a sensitivity and specificity of 57.8% (CI% 50.1-63.4) and 80.1% (CI% 74.3-85.9), respectively. Combined screening increased sensitivity and specificity up to 67.2% (CI% 52.1-71.3) and 82.7% (CI% 75.2-90.1), respectively.
Conclusion:
Combined screening for preeclampsia and FGR at 11 to 14 weeks of gestation, which includes maternal characteristics, mean blood pressure, uterine artery pulsatility index, PAPP-A and PlGF, has higher sensitivity and specificity than other screening options. Therefore, considering all these variables during screening is recommended for a superior opportunity of identifying pregnant women in risk for preeclampsia and FGR, especially in a high-risk population.
