Hypertensive disorders in pregnancy: screening by biophysical and biochemical markers at 11–13 weeks

• Published in: Ultrasound in obstetrics & gynecology 2010-06, Vol.35 (6), p.662-670
• Main Authors: Poon, L. C. Y., Akolekar, R., Lachmann, R., Beta, J., Nicolaides, K. H.
• Format: Article
• Language: English
• Subjects: Adult; Arterial hypertension. Arterial hypotension; Arteries; Biochemical markers; Biological and medical sciences; Biomarkers - blood; Blood and lymphatic vessels; Blood pressure; Cardiology. Vascular system; Cardiovascular system; Case-Control Studies; Diseases of mother, fetus and pregnancy; False Positive Reactions; Female; first trimester; Gestation; Gestational Age; Growth factors; Growth hormone; Gynecology; Gynecology. Andrology. Obstetrics; Humans; Hypertension; Investigative techniques, diagnostic techniques (general aspects); Mass Screening - methods; mean arterial pressure; Medical sciences; Obstetrics; P-selectin; Placenta; placental growth factor; Pre-eclampsia; Pre-Eclampsia - blood; Pre-Eclampsia - diagnostic imaging; Pregnancy; Pregnancy Trimester, First - blood; Pregnancy-Associated Plasma Protein-A - analysis; Pregnancy. Fetus. Placenta; Pulsatile Flow - physiology; Regression analysis; Risk factors; screening for pre‐eclampsia; Tumor necrosis factor; Ultrasonic investigative techniques; Ultrasonography, Doppler; Ultrasound; Uterine Artery - diagnostic imaging; Uterine Artery - physiopathology; uterine artery Doppler; Uterus
• ISSN: 0960-7692; 1469-0705; 1469-0705
• DOI: 10.1002/uog.7628

Objective To examine the performance of screening for pre‐eclampsia (PE) and gestational hypertension (GH) by a combination of maternal factors and various biophysical and biochemical markers at 11–13 weeks' gestation. Methods This was a case–control study of 26 cases of early PE, 90 of late PE, 85 of GH and 201 unaffected controls. Maternal history was recorded, the uterine artery with the lowest pulsatility index (L‐PI) and mean arterial pressure (MAP) were measured and stored plasma and serum were analyzed for placental growth factor (PlGF), inhibin‐A, activin‐A, tumor necrosis factor receptor‐1, matrix metalloproteinase‐9, pentraxin‐3 and P‐selectin. Results Multivariate logistic regression analysis demonstrated that significant prediction for early PE was provided by maternal factors, MAP, uterine artery L‐PI and serum PlGF. Significant prediction of late PE was provided by maternal factors, MAP, uterine artery L‐PI, PlGF, activin‐A and P‐selectin. For GH significant prediction was provided by maternal factors, MAP, uterine artery L‐PI and activin‐A. In screening by a combination of maternal factors, biophysical and biochemical markers the estimated detection rates, at a 5% false‐positive rate, were 88.5% (95% CI, 69.8–97.4%) for early PE, 46.7% (95% CI, 36.1–57.5%) for late PE and 35.3% (95% CI, 25.2–46.4%) for GH. Conclusion Combined biophysical and biochemical testing at 11–13 weeks could effectively identify women at high risk for subsequent development of hypertensive disorders in pregnancy. Copyright © 2010 ISUOG. Published by John Wiley & Sons, Ltd.