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Prediction of Preeclampsia in Twins Using First Trimester: cffDNA Fraction, PlGF, and MAP
Ran Svirsky1,2,3, Adi Sharabi-Nov4,5, Ron Maymon3,6
1Medical Genetic Unit, Department of Obstetrics and Gynecology, Samson Assuta Ashdod University Hospital, Ashdod, Israel.
Objectives:
To evaluate cell-free fetal DNA fraction (cffDNAF) as a first-trimester screening marker for preeclampsia necessitating delivery before 37 weeks' gestation in twin pregnancies alone and combined with other bio-markers.
Methods:
Women with two live fetuses were enrolled in the first trimester, and evaluated for cffDNAF as a first trimester preeclampsia marker alone, and with placental growth factor (PlGF), mean arterial pressure (MAP), and uterine artery pulsatility index (UtA-PI).
Results:
There were 20 affected women; the cffDNAF was 9.0% (IQR: 8.4%-10.3%) in the affected, compared to 14% (IQR: 11%-16%) in 163 unaffected cases (p < 0.001). The AUROC for cffDNAF was 0.73 (95% CI: 0.61-0.85, p < 0.001), PlGF had an AUROC of 0.71 (0.59-0.83, p = 0.001), MAP had AUROC of 0.61 (0.50-0.72, p = 0.053) whereas UtA-PI had AUROC of 0.54 (0.39-0.69, p > 0.05). Combining all three biomarkers yielded an AUROC of 0.89 (0.78-0.98), with a sensitivity of 81%, specificity of 90%, negative predictive value (NPV) of 97.5%, and positive predictive value (PPV) of 50.7 UtA-PI did not contribute to the AUROC.
Conclusion:
In twin pregnancies low first trimester cffDNAF effectively screens for preeclampsia necessitating delivery before 37 weeks' gestation, which is augmented with PlGF and MAP.
