Screening for pre-eclampsia by maternal factors and biomarkers at 11-13weeks' gestation

M. Y. Tan, A. Syngelaki, L. C. Poon, D. L. Rolnik, N. O'Gorman, J. L. Delgado, R. Akolekar, L. Konstantinidou, M. Tsavdaridou, S. Galeva, U. Ajdacka, F. S. Molina, N. Persico, J. C. Jani, W. Plasencia, E. Greco, G. Papaioannou, A. Wright, D. Wright, K. H. Nicolaides

Research output: Contribution to journalArticle

Abstract

Objective: To examine the performance of screening for early, preterm and term pre-eclampsia (PE) at 11-13weeks' gestation by maternal factors and combinations of mean arterial pressure (MAP), uterine artery (UtA) pulsatility index (PI), serum placental growth factor (PlGF) and serum pregnancy-associated plasma protein-A (PAPP-A). Methods: The data for this study were derived from three previously reported prospective non-intervention screening studies at 11+0 to 13+6weeks' gestation in a combined total of 61174 singleton pregnancies, including 1770 (2.9%) that developed PE. Bayes' theorem was used to combine the prior distribution of gestational age at delivery with PE, obtained from maternal characteristics, with various combinations of biomarker multiples of the median (MoM) values to derive patient-specific risks of delivery with PE at <37weeks' gestation. The performance of such screening was estimated. Results: In pregnancies that developed PE, compared to those without PE, the MoM values of UtA-PI and MAP were increased and those of PAPP-A and PlGF were decreased, and the deviation from normal was greater for early than late PE for all four biomarkers. Combined screening by maternal factors, UtA-PI, MAP and PlGF predicted 90% of early PE, 75% of preterm PE and 41% of term PE, at a screen-positive rate of 10%; inclusion of PAPP-A did not improve the performance of screening. The performance of screening depended on the racial origin of the women; on screening by a combination of maternal factors, MAP, UtA-PI and PlGF and using a risk cut-off of 1 in 100 for PE at <37weeks in Caucasian women, the screen-positive rate was 10% and detection rates for early, preterm and term PE were 88%, 69% and 40%, respectively. With the same method of screening and risk cut-off in women of Afro-Caribbean racial origin, the screen-positive rate was 34% and detection rates for early, preterm and term PE were 100%, 92% and 75%, respectively. Conclusion: Screening by maternal factors and biomarkers at 11-13weeks' gestation can identify a high proportion of pregnancies that develop early and preterm PE.

Original languageEnglish
Pages (from-to)186-195
JournalUltrasound in Obstetrics and Gynecology
DOIs
Publication statusPublished - 2018

Fingerprint

Pre-Eclampsia
Biomarkers
Mothers
Pregnancy
Uterine Artery
Pregnancy-Associated Plasma Protein-A
Intercellular Signaling Peptides and Proteins
Arterial Pressure
Bayes Theorem
Serum
Gestational Age

Keywords

  • Aspirin
  • ASPRE
  • Bayes' theorem
  • First-trimester screening
  • Mean arterial pressure
  • Placental growth factor
  • Pregnancy-associated plasma protein-A
  • Pyramid of pregnancy care
  • SPREE
  • Survival model
  • Uterine artery Doppler

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Reproductive Medicine
  • Radiology Nuclear Medicine and imaging
  • Obstetrics and Gynaecology

Cite this

Tan, M. Y., Syngelaki, A., Poon, L. C., Rolnik, D. L., O'Gorman, N., Delgado, J. L., ... Nicolaides, K. H. (2018). Screening for pre-eclampsia by maternal factors and biomarkers at 11-13weeks' gestation. Ultrasound in Obstetrics and Gynecology, 186-195. https://doi.org/10.1002/uog.19112

Screening for pre-eclampsia by maternal factors and biomarkers at 11-13weeks' gestation. / Tan, M. Y.; Syngelaki, A.; Poon, L. C.; Rolnik, D. L.; O'Gorman, N.; Delgado, J. L.; Akolekar, R.; Konstantinidou, L.; Tsavdaridou, M.; Galeva, S.; Ajdacka, U.; Molina, F. S.; Persico, N.; Jani, J. C.; Plasencia, W.; Greco, E.; Papaioannou, G.; Wright, A.; Wright, D.; Nicolaides, K. H.

In: Ultrasound in Obstetrics and Gynecology, 2018, p. 186-195.

Research output: Contribution to journalArticle

Tan, MY, Syngelaki, A, Poon, LC, Rolnik, DL, O'Gorman, N, Delgado, JL, Akolekar, R, Konstantinidou, L, Tsavdaridou, M, Galeva, S, Ajdacka, U, Molina, FS, Persico, N, Jani, JC, Plasencia, W, Greco, E, Papaioannou, G, Wright, A, Wright, D & Nicolaides, KH 2018, 'Screening for pre-eclampsia by maternal factors and biomarkers at 11-13weeks' gestation', Ultrasound in Obstetrics and Gynecology, pp. 186-195. https://doi.org/10.1002/uog.19112
Tan, M. Y. ; Syngelaki, A. ; Poon, L. C. ; Rolnik, D. L. ; O'Gorman, N. ; Delgado, J. L. ; Akolekar, R. ; Konstantinidou, L. ; Tsavdaridou, M. ; Galeva, S. ; Ajdacka, U. ; Molina, F. S. ; Persico, N. ; Jani, J. C. ; Plasencia, W. ; Greco, E. ; Papaioannou, G. ; Wright, A. ; Wright, D. ; Nicolaides, K. H. / Screening for pre-eclampsia by maternal factors and biomarkers at 11-13weeks' gestation. In: Ultrasound in Obstetrics and Gynecology. 2018 ; pp. 186-195.
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abstract = "Objective: To examine the performance of screening for early, preterm and term pre-eclampsia (PE) at 11-13weeks' gestation by maternal factors and combinations of mean arterial pressure (MAP), uterine artery (UtA) pulsatility index (PI), serum placental growth factor (PlGF) and serum pregnancy-associated plasma protein-A (PAPP-A). Methods: The data for this study were derived from three previously reported prospective non-intervention screening studies at 11+0 to 13+6weeks' gestation in a combined total of 61174 singleton pregnancies, including 1770 (2.9{\%}) that developed PE. Bayes' theorem was used to combine the prior distribution of gestational age at delivery with PE, obtained from maternal characteristics, with various combinations of biomarker multiples of the median (MoM) values to derive patient-specific risks of delivery with PE at <37weeks' gestation. The performance of such screening was estimated. Results: In pregnancies that developed PE, compared to those without PE, the MoM values of UtA-PI and MAP were increased and those of PAPP-A and PlGF were decreased, and the deviation from normal was greater for early than late PE for all four biomarkers. Combined screening by maternal factors, UtA-PI, MAP and PlGF predicted 90{\%} of early PE, 75{\%} of preterm PE and 41{\%} of term PE, at a screen-positive rate of 10{\%}; inclusion of PAPP-A did not improve the performance of screening. The performance of screening depended on the racial origin of the women; on screening by a combination of maternal factors, MAP, UtA-PI and PlGF and using a risk cut-off of 1 in 100 for PE at <37weeks in Caucasian women, the screen-positive rate was 10{\%} and detection rates for early, preterm and term PE were 88{\%}, 69{\%} and 40{\%}, respectively. With the same method of screening and risk cut-off in women of Afro-Caribbean racial origin, the screen-positive rate was 34{\%} and detection rates for early, preterm and term PE were 100{\%}, 92{\%} and 75{\%}, respectively. Conclusion: Screening by maternal factors and biomarkers at 11-13weeks' gestation can identify a high proportion of pregnancies that develop early and preterm PE.",
keywords = "Aspirin, ASPRE, Bayes' theorem, First-trimester screening, Mean arterial pressure, Placental growth factor, Pregnancy-associated plasma protein-A, Pyramid of pregnancy care, SPREE, Survival model, Uterine artery Doppler",
author = "Tan, {M. Y.} and A. Syngelaki and Poon, {L. C.} and Rolnik, {D. L.} and N. O'Gorman and Delgado, {J. L.} and R. Akolekar and L. Konstantinidou and M. Tsavdaridou and S. Galeva and U. Ajdacka and Molina, {F. S.} and N. Persico and Jani, {J. C.} and W. Plasencia and E. Greco and G. Papaioannou and A. Wright and D. Wright and Nicolaides, {K. H.}",
year = "2018",
doi = "10.1002/uog.19112",
language = "English",
pages = "186--195",
journal = "Ultrasound in Obstetrics and Gynecology",
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TY - JOUR

T1 - Screening for pre-eclampsia by maternal factors and biomarkers at 11-13weeks' gestation

AU - Tan, M. Y.

AU - Syngelaki, A.

AU - Poon, L. C.

AU - Rolnik, D. L.

AU - O'Gorman, N.

AU - Delgado, J. L.

AU - Akolekar, R.

AU - Konstantinidou, L.

AU - Tsavdaridou, M.

AU - Galeva, S.

AU - Ajdacka, U.

AU - Molina, F. S.

AU - Persico, N.

AU - Jani, J. C.

AU - Plasencia, W.

AU - Greco, E.

AU - Papaioannou, G.

AU - Wright, A.

AU - Wright, D.

AU - Nicolaides, K. H.

PY - 2018

Y1 - 2018

N2 - Objective: To examine the performance of screening for early, preterm and term pre-eclampsia (PE) at 11-13weeks' gestation by maternal factors and combinations of mean arterial pressure (MAP), uterine artery (UtA) pulsatility index (PI), serum placental growth factor (PlGF) and serum pregnancy-associated plasma protein-A (PAPP-A). Methods: The data for this study were derived from three previously reported prospective non-intervention screening studies at 11+0 to 13+6weeks' gestation in a combined total of 61174 singleton pregnancies, including 1770 (2.9%) that developed PE. Bayes' theorem was used to combine the prior distribution of gestational age at delivery with PE, obtained from maternal characteristics, with various combinations of biomarker multiples of the median (MoM) values to derive patient-specific risks of delivery with PE at <37weeks' gestation. The performance of such screening was estimated. Results: In pregnancies that developed PE, compared to those without PE, the MoM values of UtA-PI and MAP were increased and those of PAPP-A and PlGF were decreased, and the deviation from normal was greater for early than late PE for all four biomarkers. Combined screening by maternal factors, UtA-PI, MAP and PlGF predicted 90% of early PE, 75% of preterm PE and 41% of term PE, at a screen-positive rate of 10%; inclusion of PAPP-A did not improve the performance of screening. The performance of screening depended on the racial origin of the women; on screening by a combination of maternal factors, MAP, UtA-PI and PlGF and using a risk cut-off of 1 in 100 for PE at <37weeks in Caucasian women, the screen-positive rate was 10% and detection rates for early, preterm and term PE were 88%, 69% and 40%, respectively. With the same method of screening and risk cut-off in women of Afro-Caribbean racial origin, the screen-positive rate was 34% and detection rates for early, preterm and term PE were 100%, 92% and 75%, respectively. Conclusion: Screening by maternal factors and biomarkers at 11-13weeks' gestation can identify a high proportion of pregnancies that develop early and preterm PE.

AB - Objective: To examine the performance of screening for early, preterm and term pre-eclampsia (PE) at 11-13weeks' gestation by maternal factors and combinations of mean arterial pressure (MAP), uterine artery (UtA) pulsatility index (PI), serum placental growth factor (PlGF) and serum pregnancy-associated plasma protein-A (PAPP-A). Methods: The data for this study were derived from three previously reported prospective non-intervention screening studies at 11+0 to 13+6weeks' gestation in a combined total of 61174 singleton pregnancies, including 1770 (2.9%) that developed PE. Bayes' theorem was used to combine the prior distribution of gestational age at delivery with PE, obtained from maternal characteristics, with various combinations of biomarker multiples of the median (MoM) values to derive patient-specific risks of delivery with PE at <37weeks' gestation. The performance of such screening was estimated. Results: In pregnancies that developed PE, compared to those without PE, the MoM values of UtA-PI and MAP were increased and those of PAPP-A and PlGF were decreased, and the deviation from normal was greater for early than late PE for all four biomarkers. Combined screening by maternal factors, UtA-PI, MAP and PlGF predicted 90% of early PE, 75% of preterm PE and 41% of term PE, at a screen-positive rate of 10%; inclusion of PAPP-A did not improve the performance of screening. The performance of screening depended on the racial origin of the women; on screening by a combination of maternal factors, MAP, UtA-PI and PlGF and using a risk cut-off of 1 in 100 for PE at <37weeks in Caucasian women, the screen-positive rate was 10% and detection rates for early, preterm and term PE were 88%, 69% and 40%, respectively. With the same method of screening and risk cut-off in women of Afro-Caribbean racial origin, the screen-positive rate was 34% and detection rates for early, preterm and term PE were 100%, 92% and 75%, respectively. Conclusion: Screening by maternal factors and biomarkers at 11-13weeks' gestation can identify a high proportion of pregnancies that develop early and preterm PE.

KW - Aspirin

KW - ASPRE

KW - Bayes' theorem

KW - First-trimester screening

KW - Mean arterial pressure

KW - Placental growth factor

KW - Pregnancy-associated plasma protein-A

KW - Pyramid of pregnancy care

KW - SPREE

KW - Survival model

KW - Uterine artery Doppler

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U2 - 10.1002/uog.19112

DO - 10.1002/uog.19112

M3 - Article

AN - SCOPUS:85050341666

SP - 186

EP - 195

JO - Ultrasound in Obstetrics and Gynecology

JF - Ultrasound in Obstetrics and Gynecology

SN - 0960-7692

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