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Placental growth factor before 11 weeks for screening of preterm preeclampsia: The PreMoM study
Rocío López Mármol1,2, José Alejandro Ávila Cabreja3, Teresa de Haro Romero4
1Department of Obstetrics and Gynecology, Hospital Universitario Virgen de las Nieves, Granada, Spain.
Insights
Placental growth factor (PlGF) measured between 11 and 13 weeks of gestation improves preterm preeclampsia screening. Measuring PlGF before 11 weeks did not enhance prediction accuracy for preterm preeclampsia.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Clinical Chemistry
Background:
- Preterm preeclampsia (PE) poses significant risks to maternal and fetal health.
- Early screening for preterm PE is crucial for timely intervention.
- The Fetal Medicine Foundation (FMF) model incorporates various markers for PE risk assessment.
Purpose of the Study:
- To compare the predictive performance of the FMF competing-risk model for preterm PE screening.
- To evaluate the utility of placental growth factor (PlGF) measurements at different gestational ages (11-13+6 weeks vs. before 11 weeks).
Main Methods:
- A multicenter prospective cohort study involving 3448 women with singleton pregnancies.
- Collected maternal characteristics, biophysical parameters (mean arterial pressure, uterine artery pulsatility index), and PlGF levels (measured twice).
- Assessed predictive performance using detection rates (DR) at fixed screen-positive rates (SPR), AUROC, and calibration plots.
Main Results:
- The model using PlGF between 11 and 13+6 weeks showed the highest detection rates for preterm PE at 10% SPR (72.9%).
- PlGF measurement before 11 weeks did not improve screening performance compared to models without PlGF.
- The best discrimination (AUROC: 0.863) and calibration were achieved with PlGF measured between 11 and 13+6 weeks.
Conclusions:
- PlGF measurement between 11 and 13+6 weeks enhances preterm PE screening accuracy.
- PlGF measurement before 11 weeks does not offer improved predictive performance.
- Maternal and biophysical markers are valuable alternatives when PlGF is unavailable, though further validation is recommended.
Introduction:
Our objective was to compare the predictive performance of the Fetal Medicine Foundation (FMF) competing-risk model for preterm preeclampsia (PE) screening using placental growth factor (PlGF) measurements obtained at 11-13+6 weeks versus before 11 weeks of gestation.
Material And Methods:
This multicenter prospective cohort study included women with singleton pregnancies attending their routine first-trimester assessment (11+0 to 13+6 weeks) in four hospitals across Spain from 2021 to 2023. Maternal characteristics, biophysical parameters (mean arterial pressure and uterine artery pulsatility index), and biochemical markers (PlGF measured twice in each woman, before 11 weeks and between 11 and 13+6 weeks) were assessed. Risk assessment for preterm PE was estimated by the FMF algorithm. Predictive performance was evaluated by comparing detection rates (DR) at different fixed screen-positive rates (SPR), area under the receiver-operating characteristic curve (AUROC), and calibration plots. Statistical adjustments were made to account for prophylactic aspirin use.
Results:
The study population comprised 3448 women, including 19 (0.55%) who developed preterm preeclampsia and 47 (1.36%) who developed term preeclampsia. At 10% SPR, the detection rates (adjusted for aspirin use) were highest for the model incorporating PlGF between 11 and 13+6 weeks (72.9%; 95% CI, 42.2%-90.9%), compared to models with PlGF before 11 weeks (66.4%; 95% CI, 39.9%-85.4%) and without PlGF (66.0%; 95% CI, 39.3%-85.3%). Similar trends were observed at higher SPR thresholds. The best discrimination (AUROC: 0.863; 95% CI, 0.754-0.971) and calibration were also achieved by the model using PlGF between 11 and 13+6 weeks.
Conclusions:
PlGF measured before 11 weeks did not improve preterm PE screening performance. Due to the small number of cases, further validation is needed. Maternal and biophysical markers remain a viable alternative when PlGF is unavailable.
