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Routine ante-natal screening using maternal risk factors and biomarkers for preeclampsia in 11-13+6 weeks of
Anusuya Sarma1, Subrat Panda1, Ananya Das1
1Department of Obstetrics and Gynaecology, NEIGRIHMS, India.
Insights
Early prediction of preeclampsia using biomarkers like placental growth factor (PlGF) and pregnancy-associated plasma protein-A (PAPP-A) in the first trimester aids timely interventions. This study combined PlGF, PAPP-A, uterine artery Doppler, and mean arterial pressure for improved detection.
Area of Science:
- Maternal-Fetal Medicine
- Obstetrics
- Biomarker Discovery
Background:
- Preeclampsia prediction in the first trimester is crucial for managing maternal and perinatal outcomes.
- Early detection allows for prompt preventative and therapeutic interventions.
- This study focused on low-risk pregnant women.
Purpose of the Study:
- To predict preeclampsia in the first trimester (11-13+6 weeks of gestation).
- To evaluate the efficacy of serum placental growth factor (PlGF), serum pregnancy-associated plasma protein-A (PAPP-A), uterine artery Doppler indices, and mean arterial pressure (MAP) in prediction.
- To assess the potential for early initiation of preventative measures and timely therapeutic interventions.
Main Methods:
- An observational, longitudinal, prospective study design.
- Recruitment of pregnant women with singleton pregnancies at 11-13+6 weeks gestation.
- Measurement of MAP, bilateral uterine artery Doppler indices, serum PAPP-A, and serum PlGF.
- Regular follow-up until pregnancy termination to record preeclampsia incidence.
- Statistical analysis including Chi-square/Fisher exact test, sensitivity, and specificity analysis.
Main Results:
- Out of 139 women, 27 (19%) developed preeclampsia (10 early, 17 late).
- Combined parameters achieved 70% sensitivity for early preeclampsia and 64.7% for late preeclampsia.
- Overall prediction of preeclampsia showed 66.7% sensitivity, 74.1% specificity, 38.3% positive predictive value (PPV), and 72% negative predictive value (NPV).
Conclusions:
- Maternal biomarkers (serum PAPP-A, serum PlGF), uterine artery pulsatility index (PI), and MAP demonstrate significant potential for first-trimester preeclampsia prediction.
- A sensitivity of 70% for early and 64.71% for late preeclampsia detection is achievable.
- These findings support early initiation of preventative measures and timely therapeutic interventions to improve maternal and perinatal health outcomes.
Background:
Prediction of preeclampsia in first trimester can lead to early initiation of preventative measures, as well as timely therapeutic intervention, that will prevent the maternal and perinatal morbidity and mortality. This study, prediction of preeclampsia at 11-13+6 weeks of gestation, was conducted by using serum placental growth factor (PlGF), serum pregnancy associated plasma protein - A (PAPP-A), uterine artery Doppler indices, and mean arterial pressure (MAP), in low-risk pregnant women.
Methods:
It is an observational longitudinal prospective study. Pregnant women with singleton pregnancies of gestational age 11-13+6 weeks were recruited. MAP, bilateral uterine artery Doppler indices, serum PAPP-A, and PlGF were measured. The follow-up of the patients was regularly done till termination of pregnancy and incidence of preeclampsia were noted. Qualitative variables were compared using Chi-square/Fisher exact test, and sensitivity and specificity of each test were analyzed.
Result:
Among 139 women, 27 (19%) developed preeclampsia, out of which 10 had early preeclampsia and 17 developed late preeclampsia. By combining all the parameters, the sensitivity in detecting early preeclampsia was found to be 70% and for late preeclampsia cases, 64.7%. The sensitivity of all the parameters in predicting cases of preeclampsia in general is 66.7%, specificity is 74.1%, PPV is 38.3%, and NPV is 72%.
Conclusion:
The maternal biomarkers serum PAPP-A, serum PlGF, uterine artery PI, MAP have sensitivity of 70% in detecting early preeclampsia cases and for late preeclampsia cases, 64.71%, in first trimester and it will help in early initiation of preventative measures as well as timely therapeutic intervention.
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