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Serum PlGF compared with PAPP-A in first trimester screening for preterm pre-eclampsia: Adjusting for the effect of
David Wright1, Min Yi Tan2, Neil O'Gorman2
1Institute of Health Research, University of Exeter, Exeter, UK.
Insights
First-trimester screening for preterm pre-eclampsia (PE) using placental growth factor (PlGF) shows superior predictive performance compared to pregnancy-associated plasma protein-A (PAPP-A). PlGF significantly improves detection rates when combined with maternal factors and other biomarkers.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Biomarker Research
Background:
- Preterm pre-eclampsia (PE) is a significant cause of maternal and neonatal morbidity.
- First-trimester screening aims to identify pregnancies at high risk for PE.
- Current screening methods utilize maternal risk factors, mean arterial pressure (MAP), and uterine artery pulsatility index (UtA-PI).
Purpose of the Study:
- To compare the predictive performance of serum placental growth factor (PlGF) versus pregnancy-associated plasma protein-A (PAPP-A) for preterm PE detection in the first trimester.
- To evaluate the added value of PlGF and PAPP-A in combination with maternal risk factors, MAP, and UtA-PI.
- To assess the impact of aspirin treatment on screening performance.
Main Methods:
- Prospective multicentre screening studies involving over 25,000 singleton pregnancies.
- Utilized a competing risks model to estimate patient-specific risks of preterm PE.
- Compared detection rates (DR) of PlGF versus PAPP-A using McNemar's test, with adjustments for aspirin use.
Main Results:
- Placental growth factor (PlGF) significantly improved the detection rate of preterm PE across various screening combinations.
- At a 10% screen-positive rate, PlGF increased DR by 18.4% (maternal factors), 19.9% (maternal factors + MAP), and 7.0% (maternal factors + MAP + UtA-PI).
- Pregnancy-associated plasma protein-A (PAPP-A) did not significantly enhance DR when added to any biomarker combination.
Conclusions:
- First-trimester serum PlGF demonstrates superior predictive performance for preterm PE compared to PAPP-A.
- PlGF is a valuable addition to first-trimester screening protocols for identifying pregnancies at risk of preterm PE.
- These findings support the use of PlGF in routine first-trimester screening for improved PE prediction.
Objective:
To compare the predictive performance for preterm-pre-eclampsia (PE) in first-trimester screening by serum placental growth factor (PlGF) versus pregnancy associated plasma protein-A (PAPP-A), in combination with maternal risk factors, mean arterial pressure (MAP) and uterine artery pulsatility index (UtA-PI), after adjustment for the effect of aspirin in women receiving this treatment.
Design:
Non-intervention multicentre screening studies for PE in singleton pregnancies.
Setting:
Maternity hospitals.
Population:
Two independent prospective studies of 8775 and 16 451 women with singleton pregnancies attending for routine assessment at 11+0 -13+6 weeks' gestation.
Methods:
The competing risks model was used to estimate patient-specific risks of delivery with PE at <37 weeks' gestation based on maternal risk factors and combinations with MAP, UtA-PI and either PlGF or PAPP-A. McNemar's test was used to compare the detection rate (DR) of preterm-PE of screening utilising PlGF versus PAPP-A, after adjustments for the effects of aspirin.
Main Outcome Measure:
Predictive performance for preterm-PE.
Results:
In the combined data of 25 226 women, including 678 (2.7%) who developed PE, there were 194(0.8%) with preterm-PE. Addition of PlGF improved the DR of preterm-PE, at 10% screen positive rate, by 18.4% (95% CI 12.2-24.6) in screening by maternal risk factors, by 19.9% (95% CI 13.6-26.2) in screening by maternal factors and MAP, and by 7.0% (95% CI 2.3-11.6) in screening by maternal factors, MAP and UtA-PI. PAPP-A did not significantly improve the DR provided by any combination of biomarkers.
Conclusion:
The predictive performance of first trimester PlGF for preterm-PE is superior to that of PAPP-A.
