Screening for preeclampsia in the first trimester of pregnancy in routine clinical practice in Hungary

• Published in: Journal of biotechnology 2019-07, Vol.300, p.11-19
• Main Authors: Orosz, Laszlo, Orosz, Gergo, Veress, Lajos, Dosa, Diana, Orosz Sr, Laszlo, Arany, Ibolya, Fabian, Antal, Medve, Laszlo, Pap, Karoly, Karanyi, Zsolt, Toth, Zoltan, Poka, Robert, Than, Nandor Gabor, Torok, Olga
• Format: Article
• Language: English
• Subjects: Biomarkers - metabolism; Blood pressure; Case-Control Studies; Female; First trimester; Humans; Hungary - epidemiology; Placental growth factor; Pre-Eclampsia - diagnosis; Pre-Eclampsia - epidemiology; Preeclampsia; Pregnancy; Pregnancy Trimester, First; Pregnancy-Associated Plasma Protein-A - metabolism; Prenatal Diagnosis - methods; Prenatal Diagnosis - standards; Prospective Studies; Screening; Software; Uterine artery Doppler
• ISSN: 0168-1656; 1873-4863
• DOI: 10.1016/j.jbiotec.2019.04.017

•Preeclampsia is one of the leading causes of fetomaternal morbidity and mortality.•First-trimester screening for preeclampsia is feasible during routine ultrasound scan.•The use of Fetal Medicine Foundation guidelines are recommended for the screening.•Placental growth factor did not improve the detection rate among Hungarian pregnants.•Studies are required for placental growth factor distribution in Eastern Europe. We aimed to evaluate the contribution of different factors in the Fetal Medicine Foundation algorithms for preeclampsia (PE) risk calculation during first-trimester screening in Hungary. We selected subjects for the nested case-control study from a prospective cohort of 2545 low-risk pregnancies. Eighty-two patients with PE and 82 gestational age-matched controls were included. Individual PE risk was calculated using two risk-assessing softwares. Using Astraia 2.3.1, considering maternal characteristics and biophysical parameters only, detection rates (DR) were 63.6% for early-PE and 67.6% for late-PE. When we added placenta associated plasma protein A (PAPP-A) to the risk calculation, DRs decreased to 54.5% and 64.8% respectively. Using Astraia 2.8.2 with maternal characteristics and biophysical parameters resulted in the DRs of 63.6% (early-PE) and 56.3% (late-PE). If we added PAPP-A to the risk calculation, DRs improved to 72.7% and 54.9%. The addition of placental growth factor (PlGF) did not increase detection rates in either calculation. In conclusion, using maternal characteristics, biophysical parameters, and PAPP-A, an acceptable screening efficacy could be achieved for early-PE during first-trimester screening. Since PlGF did not improve efficacy in our study, we suggest setting new standard curves for PlGF in Eastern European pregnant women, and the evaluation of novel biochemical markers.