Diagnostic accuracy of first‐trimester combined screening for early‐onset and preterm pre‐eclampsia at 8–10 compared with 11–13 weeks' gestation

• Published in: Ultrasound in obstetrics & gynecology 2021-01, Vol.57 (1), p.84-90
• Main Authors: Mendoza, M., Garcia‐Manau, P., Arévalo, S., Avilés, M., Serrano, B., Sánchez‐Durán, M. á., Garcia‐Ruiz, I., Bonacina, E., Carreras, E.
• Format: Article
• Language: English
• Subjects: Adult; Biomarkers - blood; early‐onset pre‐eclampsia; Female; first‐trimester; Humans; Infant, Newborn; Middle Cerebral Artery - diagnostic imaging; Middle Cerebral Artery - embryology; Original Paper; Original Papers; Placenta Growth Factor - blood; PlGF; Pre-Eclampsia - blood; Pre-Eclampsia - diagnosis; Pregnancy; Pregnancy Trimester, First; Pregnancy-Associated Plasma Protein-A - analysis; pre‐eclampsia; Prospective Studies; Pulsatile Flow; ROC Curve; screening; Uterine Artery - diagnostic imaging; uterine artery Doppler
• ISSN: 0960-7692; 1469-0705
• DOI: 10.1002/uog.22071

ABSTRACT Objectives To compare the ability of first‐trimester combined screening for pre‐eclampsia (PE) to predict early‐onset and preterm PE when pregnancy‐associated plasma protein‐A (PAPP‐A) and placental growth factor (PlGF) were assessed before vs after 11 weeks' gestation. Methods This was a secondary analysis of a prospective cohort study of singleton pregnancies undergoing routine first‐trimester screening conducted at Vall d'Hebron University Hospital, Barcelona, Spain, between October 2015 and September 2017. Demographic characteristics, obstetric history, maternal history and biophysical markers (mean uterine artery pulsatility index and mean arterial blood pressure (MAP)) were recorded at the first‐trimester scan (at 11 + 0 to 13 + 6 weeks' gestation). Maternal serum concentrations of PAPP‐A and PlGF were assessed from the routine first‐trimester blood test (at 8 + 0 to 13 + 6 weeks). Women were classified into two groups depending on whether serum biomarkers were assessed at 8 + 0 to 10 + 6 weeks or at 11 + 0 to 13 + 6 weeks. Probability scores for early‐onset and preterm PE were calculated by using two different algorithms: the multivariate Gaussian‐distribution model and The Fetal Medicine Foundation (FMF) competing‐risks model. Receiver‐operating‐characteristics (ROC) curves were produced and detection rates at fixed 5% and 10% false‐positive rates were computed to compare the performance of these algorithms when PAPP‐A and PlGF were assessed before vs after 11 weeks. Results Of the 2641 women included, serum biomarkers were assessed before 11 weeks in 1675 (63.4%) and at or after 11 weeks in 966 (36.6%). Of these, 90 (3.4%) women developed PE, including 11 (0.4%) cases of early‐onset PE and 30 (1.1%) of preterm PE. Five (45.5%) cases of early‐onset and 16 (53.3%) of preterm PE were identified in the group in which serum biomarkers were assessed at 8 + 0 to 10 + 6 weeks and six (54.5%) cases of early‐onset and 14 (46.7%) of preterm PE in the group in which serum biomarkers were assessed at 11 + 0 to 13 + 6 weeks. In the prediction of early‐onset and preterm PE using the Gaussian algorithm, no differences were observed between the areas under the ROC curves (AUCs) when PAPP‐A and PlGF were measured before or after 11 weeks. In the prediction of early‐onset and preterm PE using the FMF algorithm, no differences were observed between AUCs for any of the combinations used for risk calculation when the serum biomarkers were obtained before vs af