Performance of a first-trimester screening of preeclampsia in a routine care low-risk setting

• Published in: American journal of obstetrics and gynecology 2013-03, Vol.208 (3), p.203.e1-203.e10
• Main Authors: Scazzocchio, Elena, MD, Figueras, Francesc, PhD, Crispi, Fatima, PhD, Meler, Eva, MD, Masoller, Narcís, MD, Mula, Raquel, MD, Gratacos, Eduard, PhD
• Format: Article
• Language: English
• Subjects: Adult; blood pressure; Blood Pressure - physiology; Female; Humans; Obstetrics and Gynecology; Pre-Eclampsia - blood; Pre-Eclampsia - diagnosis; Pre-Eclampsia - diagnostic imaging; Predictive Value of Tests; preeclampsia; Pregnancy; Pregnancy Trimester, First; Pregnancy-Associated Plasma Protein-A - metabolism; Prospective Studies; screening; Sensitivity and Specificity; Ultrasonography; Uterine Artery - diagnostic imaging; uterine artery Doppler
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2012.12.016

Objective We sought to evaluate the effectiveness of an integrated first-trimester screening test to predict preeclampsia (PE). Study Design A prospective cohort of singleton pregnancies underwent routine first-trimester screening from 2009 through 2011 (n = 5759). A logistic regression-based predictive model for early- and late-onset PE was constructed based on: maternal characteristics; levels of pregnancy-associated plasma protein-A and free β-human chorionic gonadotropin at 8-12 weeks; and blood pressure and uterine artery Doppler at 11.0-13.6 weeks. Results Of the 5170 enrolled participants, 136 (2.6%) developed PE (early PE: 26 [0.5%]; late PE: 110 [2.1%]). At 5% and 10% false-positive rates, detection rates were 69.2% and 80.8% for early PE (area under the curve, 0.95; 95% confidence interval, 0.94–0.98) and 29.4% and 39.6% for late PE (area under the curve, 0.71; 95% confidence interval, 0.66–0.76), respectively. Conclusion First-trimester screening combining maternal factors with uterine artery Doppler, blood pressure, and pregnancy-associated plasma protein-A is useful to predict PE in a routine care setting.