First trimester maternal serum PIGF, free β-hCG, PAPP-A, PP-13, uterine artery Doppler and maternal history for the prediction of preeclampsia

Placenta. 2012 Jun;33(6):495-501. doi: 10.1016/j.placenta.2012.03.003. Epub 2012 Mar 28.

Abstract

Objective: To evaluate the detection of pregnancy hypertensive disorders by integrating maternal history, serum biomarkers and uterine artery Doppler in the first trimester.

Methods: We prospectively recruited 2118 women that underwent an 11-13 weeks aneuploidy screening. We gathered information on maternal history, uterine artery Doppler and serum biomarkers (PAPP-A, PlGF, PP-13 and free β-hCG). Models were developed for the prediction of overall preeclampsia (PE), early-onset PE, late-onset PE and gestational hypertension (GH). For each outcome, we performed a multivariate logistic regression starting from the saturated model: adopting a step-down procedure we excluded all factors not statistically significant (p > 0.05). Sensitivity models only for statistically significant parameters were calculated from the ROC curves for fixed false-positive rates (FPR).

Results: Among 2118 women, 46 (2.17%) developed GH and 25 (1.18%) were diagnosed with PE, including 12 (0.57%) early-onset PE and 13 (0.61%) late-onset PE. For a fixed FPR of 10 and 5%, serum PlGF, free β-hCG and chronic hypertension identified respectively 67 and 75% of women who developed early-onset PE. In the model for the prediction of overall PE the combination of the uterine artery Doppler pulsatility index (UtA PI) with PlGF and chronic hypertension reached a sensitivity of 60% for a 20% of FPR.

Conclusion: An integration of maternal characteristics and first trimester maternal serum biomarkers (free β-hCG and PlGF) provided a possible screening for early-onset PE. In the overall PE model, UtA PI turned out to be statistically significant but did not improve the detection rate.

MeSH terms

  • Adult
  • Biomarkers / blood
  • Chorionic Gonadotropin, beta Subunit, Human / blood*
  • Cohort Studies
  • Female
  • Galectins / blood
  • Humans
  • Hypertension, Pregnancy-Induced / diagnosis
  • Hypertension, Pregnancy-Induced / etiology
  • Placenta Growth Factor
  • Pre-Eclampsia / diagnosis*
  • Pre-Eclampsia / diagnostic imaging
  • Pregnancy
  • Pregnancy Complications / diagnostic imaging
  • Pregnancy Proteins / blood*
  • Pregnancy Trimester, First
  • Pregnancy-Associated Plasma Protein-A / metabolism*
  • Prospective Studies
  • Ultrasonography, Prenatal
  • Uterine Artery / diagnostic imaging*
  • Uterus / blood supply
  • Uterus / diagnostic imaging

Substances

  • Biomarkers
  • Chorionic Gonadotropin, beta Subunit, Human
  • Galectins
  • LGALS13 protein, human
  • PGF protein, human
  • Pregnancy Proteins
  • Placenta Growth Factor
  • Pregnancy-Associated Plasma Protein-A