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First-trimester screening for pre-eclampsia and small for gestational age: A comparison of the gaussian and Fetal
Berta Serrano1, Erika Bonacina1, Carlota Rodo1
1Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
Insights
The Gaussian and Fetal Medicine Foundation (FMF) algorithms show similar first-trimester prediction accuracy for pre-eclampsia (PE) and small for gestational age (SGA). The Gaussian algorithm showed slight advantages in predicting early-onset PE with specific markers.
Area of Science:
- Maternal-fetal medicine
- Obstetrics
- Perinatal diagnostics
Background:
- First-trimester prediction of pre-eclampsia (PE) and small for gestational age (SGA) is crucial for timely intervention.
- The Fetal Medicine Foundation (FMF) algorithm is the most widely used predictive tool.
- The Gaussian algorithm has shown promising results but requires external validation.
Purpose of the Study:
- To compare the predictive accuracy of the Gaussian and FMF algorithms for PE and SGA.
- To evaluate the external validity of the Gaussian algorithm against the established FMF algorithm.
- To assess algorithm performance using various marker combinations in a real-world clinical setting.
Main Methods:
- Secondary analysis of a prospective cohort study involving 2641 singleton pregnancies.
- Calculation of areas under the curve (AUC) for predictive performance of both algorithms.
- Comparison of predictive accuracy for early-onset and preterm PE and SGA.
Main Results:
- Both FMF and Gaussian algorithms demonstrated comparable predictive performance for most PE and SGA outcomes.
- The Gaussian algorithm showed a statistically significant advantage in predicting early-onset PE when combined with mean arterial blood pressure (MAP) and either pregnancy-associated plasma protein A or placental growth factor, or with MAP alone.
- Overall, similar predictive capabilities were observed across various marker combinations.
Conclusions:
- The first-trimester Gaussian and FMF algorithms exhibit similar predictive performance for PE and SGA in a routine care setting.
- These findings support the external validity of the FMF algorithm within a Spanish population.
- The Gaussian algorithm may offer specific advantages for early-onset PE prediction with certain marker combinations.
Objective:
Pre-eclampsia (PE) and small for gestational age (SGA) can be predicted from the first trimester. The most widely used algorithm worldwide is the Fetal Medicine Foundation (FMF) algorithm. The recently described Gaussian algorithm has reported excellent results although it is unlikely to be externally validated. Therefore, as an alternative approach, we compared the predictive accuracy for PE and SGA of the Gaussian and FMF algorithms.
Methods:
Secondary analysis of a prospective cohort study was conducted at Vall d'Hebron University Hospital (Barcelona) with 2641 singleton pregnancies. The areas under the curve for the predictive performance for early-onset and preterm PE and early-onset and preterm SGA were calculated with the Gaussian and FMF algorithms and subsequently compared.
Results:
The FMF and Gaussian algorithms showed a similar predictive performance for most outcomes and marker combinations. Nevertheless, significant differences for early-onset PE prediction favored the Gaussian algorithm in the following combinations: mean arterial blood pressure (MAP) with pregnancy-associated plasma protein A, MAP with placental growth factor, and MAP alone.
Conclusions:
The first-trimester Gaussian and FMF algorithms have similar performances for PE and SGA prediction when applied with all markers within a routine care setting in a Spanish population, adding evidence to the external validity of the FMF algorithm.
