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- Title
Prediction of Preeclampsia in Nulliparous Women according to First Trimester Maternal Factors and Serum Markers.
- Authors
Pihl, Kasper; Sørensen, Steen; Stener Jørgensen, Finn; Stener Jørgensen, Finn
- Abstract
<bold>Objective: </bold>To evaluate the performance of maternal risk factors (BMI and mean arterial pressure [MAP]) and first-trimester maternal serum markers in the early prediction of preeclampsia (PE) in nulliparous women.<bold>Material and Methods: </bold>This was a case-cohort study based on a cohort of 14,207 nulliparous women. A total of 213 cases with term PE (from 37 weeks + 0 days) and 55 cases with preterm PE (before 37 weeks + 0 days) were identified and validated. Randomly, 449 controls were selected. Serum samples previously collected for the double test (pregnancy-associated plasma protein A [PAPP-A] and free β human chorionic gonadotrophin [hCGβ]) as part of the first-trimester screening program were retrieved and analyzed for placental growth factor (PlGF), soluble fms-like tyrosine kinase 1 (sFlt-1), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and neutrophil gelatinase-associated lipocalin (NGAL). Concentrations were transformed to multiples of the median (MoM). Multivariate regression analysis was used for prediction models. Receiver-operating characteristics (ROC) curves were used for evaluation of the screening performance.<bold>Results: </bold>In preterm PE, the PlGF (0.79 MoM), sFlt-1 (0.86 MoM), NGAL (1.15 MoM), and PAPP-A (0.89 MoM) medians were significantly altered. In term PE, PlGF (0.90 MoM) and NT-proBNP (0.86 MoM) medians were significantly reduced. The combination of MAP and PlGF yielded a 39% detection rate of preterm PE for a 10% false-positive rate. The combination of MAP, BMI, and PlGF yielded a 33% detection rate of term PE with a 10% false-positive rate.<bold>Conclusion: </bold>First-trimester MAP, maternal serum PlGF, and NGAL are markers of preterm PE. Maternal serum sFlt-1 is a significant marker of preterm PE, but only early in the first trimester. First-trimester maternal serum NT-proBNP is not a predictor of PE. Screening performance for PE with these markers individually or in combination is modest.
- Subjects
BIOMARKERS; PLACENTAL growth factor; FORECASTING; PREECLAMPSIA; BLOOD proteins; PREECLAMPSIA diagnosis; ARTERIAL physiology; BLOOD pressure; PREGNANCY proteins; FIRST trimester of pregnancy; CELL receptors; PEPTIDE hormones; PEPTIDES; CHORIONIC gonadotropins; BLOOD
- Publication
Fetal Diagnosis & Therapy, 2020, Vol 47, Issue 4, p277
- ISSN
1015-3837
- Publication type
journal article
- DOI
10.1159/000503229