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Predictive performance of Fetal Medicine Foundation first-trimester screening algorithm for pre-eclampsia according
A S L Kjaer1,2, I Riishede2,3, L Rode4,5
1The Fertility Clinic, Department of Gynaecology, Fertility and Obstetrics, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
Summary
Assisted reproductive technology (ART) pregnancies show a higher incidence of pre-eclampsia (PE) compared to spontaneous conception. The Fetal Medicine Foundation (FMF) screening algorithm demonstrates high detection rates for PE across all conception methods.
Area of Science:
- Reproductive Medicine
- Maternal-Fetal Medicine
- Obstetrics
Background:
- Pre-eclampsia (PE) is a significant complication of pregnancy.
- Assisted reproductive technology (ART) and ovulation induction (OI) are increasingly used for conception.
- The predictive performance of first-trimester PE screening in these populations requires investigation.
Purpose of the Study:
- To assess the incidence of PE in pregnancies conceived via ART, OI, and spontaneous conception (SC).
- To evaluate the predictive performance of the Fetal Medicine Foundation (FMF) first-trimester PE screening algorithm across these groups.
- To identify potential differences in PE risk markers and outcomes among ART subgroups.
Main Methods:
- Prospective multicenter study of 8157 singleton pregnancies undergoing first-trimester screening.
- Data collected included maternal characteristics, mode of conception, mean arterial pressure (MAP), uterine artery pulsatility index, PAPP-A, and placental growth factor.
- The FMF algorithm was used to calculate individual PE risk; obstetric outcomes were recorded from the national birth registry.
Main Results:
- PE incidence was highest in ART (7.3%) and OI (5.1%) groups compared to SC (3.4%).
- ART subgroups showed varied PE incidence (FET 8.3%, fresh ET 6.4%, OD 12.3%) and differing preterm vs. term PE distributions.
- The FMF algorithm had higher detection rates for overall PE in ART (69.2%) vs. SC (35.7%) pregnancies, with significantly higher screen-positive rates in ART and OI groups.
Conclusions:
- ART pregnancies exhibit a higher PE incidence, with distinct preterm/term PE patterns among ART subgroups.
- The FMF first-trimester PE screening algorithm shows high detection rates but varying screen-positive rates across conception groups.
- ART-subgroup-specific adjustments to the FMF algorithm may enhance predictive performance, necessitating tailored management and communication.
Keywords:
Fetal Medicine Foundationassisted reproductive technologycompeting‐risks modelsfresh embryo transferfrozen embryo transferoocyte donationovulation inductionpre‐eclampsiascreening
