Prediction of preeclampsia during extended first-trimester combined prenatal screening
Objective. To evaluate the possibility of using anamnestic data, biophysical indicators, and biochemical markers for combined prenatal screening to predict preeclampsia in the first trimester of pregnancy.Lemeshevskaya T.V., Pribushenya O.V.
Subjects and methods. 511 patients (27 with preeclampsia) with singleton pregnancy at 10-13 weeks gestation were examined. Anamnestic data, systolic blood pressure (SBP), and uterine artery pulsatility index (PI), and trophoblastic proteins were explored. The diagnostic threshold (cut-off point) of the analyzed factors was determined by ROC analysis.
Results. The normal range was 0.94-1.10 MoM for SBP, 0.87-1.27 MoM for PI, the median placental growth factor was 1.02 (0.67-1.59) MoM. The authors developed a scoring table to predict preeclampsia, using 9 factors, for each a diagnostic cut-off being calculated in scores. A patient with a sum equal to (-2) points or more (the diagnostic cut-off) belongs to a group at high risk for preeclampsia.
Conclusion. The method developed to predict preeclampsia in the first trimester of pregnancy has a useful estimate (AUC = 0.82±0.052; LR+, 3.21; and LR-, 0.29) and can be used in clinical practice.
Keywords
preeclampsia
combined prenatal screening
Supplementary Materials
- Table 1. Comparative characteristics of age, anthropometric and anamnestic data in study groups
- Table 2. Evaluation results of MAP, fetal ultrasound and uterine artery Doppler in the study groups, Me (25%-75%)
- Table 3. Biochemical markers results in the study groups, МоМ, Ме (25%-75%)
- Table 4. ROC-analysis findings of anthropometric data, biophysical indicators and biochemical markers
- Table 5. Probability of risk factors presence in preeclampsia patients based on odds ratio
- Table 6. Table of preeclampsia prediction in the first trimester of pregnancy
- Table 7. ROC-analysis findings of the preeclampsia prediction method
References
1. World Health Organization. Recommendations for prevention and treatment of pre-eclampsia and eclampsia. Geneva: WHO Press; 2011. 38p.
2. Roberge S., Nicolaides K.H., Demers S., Villa P., Bujold E. Prevention of perinatal death and adverse perinatal outcome using low-dose aspirin: a meta-analysis. Ultrasound Obstet. Gynecol. 2013; 41(5): 491-9. doi: 10.1002/uog.12421.
3. Villa P.M., Kajantie E., Raikkonen K. Pesonen A.K., Hamalainen E., Vainio M. et al. Aspirin in the prevention of pre-eclampsia in high-risk women: a randomised placebo-controlled PREDO Trial and a meta-analysis of randomised trials. BJOG. 2013; 120(1): 64-74. doi: 10.1111/j.1471-0528.2012.03493.x.
4. The Fetal Medicine Foundation. Protocol for measurement of uterine artery pulsatility index. Available at: https://fetalmedicine.org/research/assess/ preeclampsia/background
5. National Heart Foundation of Australia. Guideline for the diagnosis and management of hypertension in adults. 2016. Available at: https://www.heartfoundation.org.au/images/uploads/publications/PRO-167_Hypertension-guideline-2016_WEB.pdf
6. Poon L.C., Zymeri N.A., Zamprakou A., Syngelaki A., Nicolaides K.H. Protocol for measurement of mean arterial pressure at 11-13 weeks gestation. Fetal Diagn. Ther. 2012; 31(1): 42-8. doi: 10.1159/000335366.
7. Петри А., Сэбин К. Наглядная статистика в медицине. Пер. с англ. под ред. В.П. Леонов В.П., ред. М.: ГЭОТАР-Медиа; 2015. 216с. [Petrie А., Sabin С. Medical Statistics at a Glance. 3th ed. New York: Wiley-Blackwell; 2009. 175 p.]
8. Министерство здравоохранения Республики Беларусь, Государственное учреждение «Республиканский научно-практический центр медицинских технологий, информатизации, управления и экономики здравоохранения». Здравоохранение в Республике Беларусь: официальный статистический сборник за 2015 г. Минск: ГУ РНМБ; 2016. 281с. [Ministry of Health of the Republic of Belarus, State Institution “Republican Scientific and Practical Center of Medical Technologies, Informatization, Management and Health Economics”. Public health in the Republic of Belarus: official statistical compilation for 2015 Minsk: GU RNIB; 2016. 281p. (in Russian)]
9. Akolekar R., Syngelaki A., Sarquis R., Zvanca M., Nicolaides K.H. Prediction of early, intermediate and late pre-eclampsia from maternal factors, biophysical and biochemical markers at 11-13 weeks. Prenat. Diagn. 2011; 31(1): 66-74. doi: 10.1002/pd.2660.
10. Gregg A.R. Preeclampsia. In: Rimoin D.L., Pyeritz R.E., Bruce R.K., eds. Emery and Rimoin’s principles and practice of medical genetics. 6th ed. Elsevier Ltd.; 2013: 1470-83.
11. Audibert F., Boucoiran I., An N., Aleksandrov N., Delvin E., Bujold E. et al. Screening for preeclampsia using first-trimester serum markers and uterine artery Doppler in nulliparous women. Am. J. Obstet. Gynecol. 2010; 203(4): 383. e1-8. doi: 10.1016/j.ajog.2010.06.014.
12. The Darwin Web Server. Interpreting diagnostic tests: the area under an ROC curve. Available at: http://gim.unmc.edu/dxtests/roc3.htm
13. Николаидес К. Ультразвуковое исследование в 11-13+6 недель беременности. Пер. с англ. Михайлов А., Некрасова Е. СПб.: Петрополис; 2007. 144с. Available at: http://www.fetalmedicine.com/synced/fmf/FMF-Russian.pdf [Nicolaides K.H. The 11-13+6 weeks scan. London: Fetal Medicine Foundation; 2004. 113p.]
Received 16.08.2017
Accepted 22.09.2017
About the Authors
Tatyana V. Lemeshevskaya, MD, PhD-student of the Scientific Laboratory for Medical Genetics, Republican Scientific and Practical Center “Mother and Child”. 220053, Belarus, Minsk, Orlovskaya str. 66. Tel.: (37517) 233-25-86. E-mail: tv.lemeshevskaya@gmail.com. ORCID ID 0000-0003-3911-2715Oksana V. Pribushenya, MD, PhD, chief of the Scientific Laboratory for Medical Genetics, Republican Scientific and Practical Center “Mother and Child”. 220053, Belarus, Minsk, Orlovskaya str. 66
For citations: Lemeshevskaya T.V., Pribushenya O.V. Prediction of preeclampsia during extended first-trimester combined prenatal screening. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2017; (12): 52-9. (in Russian)
https://dx.doi.org/10.18565/aig.2017.12.52-59
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