Fetal Medicine Unit, University of Chile Hospital, Santiago, Chile.
Ultrasound Obstet Gynecol. 2013 May;41(5):538-44. doi: 10.1002/uog.12264.
To develop a predictive model for pre-eclampsia using clinical, biochemical and ultrasound markers during the first trimester of pregnancy.
This was a nested case-control study within a pre-eclampsia screening project that involved 5367 asymptomatic pregnant women undergoing routine transvaginal uterine artery (UtA) Doppler at 11 + 0 to 13 + 6 weeks. Following exclusions, there were 70 pregnant women who later developed pre-eclampsia and 289 control patients enrolled during the first trimester who had serum or plasma samples taken at enrolment available for the purposes of this study. Of these, 17 pregnancies were diagnosed with early-onset (delivery < 34 weeks) pre-eclampsia and 53 with late-onset (delivery ≥ 34 weeks) pre-eclampsia. The lowest, highest and mean of left and right UtA pulsatility indices (PI) were calculated. Blood samples were stored at -84 °C until biochemical analysis for markers of vasculogenesis was performed. The distributions of the lowest UtA-PI and the biochemical markers were adjusted for maternal characteristics, expressed as multiples of the median (MoM), and compared between groups. Logistic regression analysis was used to evaluate if any variable was significantly associated with pre-eclampsia.
Pregnancies that later developed pre-eclampsia were associated with higher maternal prepregnancy body mass index. An increased lowest UtA-PI was significantly associated with both early- and late-onset disease. Placental growth factor (PlGF) MoM was significantly reduced in women who later developed early- or late-onset pre-eclampsia compared with controls (median (interquartile range), 0.69 (0.33-1.46) and 1.10 (0.39-1.56), respectively, vs 1.19 (0.65-1.84), P < 0.05). Different combined models were generated by logistic regression analysis, and the detection rate with a fixed 10% false-positive rate was 47% and 29% for early- and late-onset pre-eclampsia, respectively.
Pregnancies that later developed early or late pre-eclampsia were characterized by impaired placentation and an anti-angiogenic state during the first trimester of pregnancy. Regression models which include maternal characteristics, UtA Doppler and PlGF can apparently predict approximately half of pregnancies that will be complicated by early-onset pre-eclampsia. We believe more research in several areas is needed to aid in the creation of a better and more population-specific screening test for pre-eclampsia during the first trimester of pregnancy.
利用妊娠早期的临床、生化和超声标志物，建立子痫前期的预测模型。
这是一项在子痫前期筛查项目中进行的嵌套病例对照研究，共纳入 5367 例无症状孕妇，在 11+0 至 13+6 周时进行经阴道子宫动脉（UtA）多普勒检查。排除后，有 70 例孕妇随后发展为子痫前期，289 例在妊娠早期接受了血清或血浆样本采集，用于本研究。其中，17 例被诊断为早发型（分娩<34 周）子痫前期，53 例为晚发型（分娩≥34 周）子痫前期。计算左、右 UtA 搏动指数（PI）的最低值、最高值和平均值。将血液样本储存在-84°C，直到进行血管生成标志物的生化分析。最低 UtA-PI 和生化标志物的分布按母体特征进行调整，以中位数倍数（MoM）表示，并在组间进行比较。采用 logistic 回归分析评估任何变量与子痫前期是否显著相关。
随后发生子痫前期的妊娠与较高的孕前体重指数相关。最低 UtA-PI 的增加与早发型和晚发型疾病均显著相关。与对照组相比，早发型或晚发型子痫前期患者的胎盘生长因子（PlGF）MoM 明显降低（中位数（四分位距），0.69（0.33-1.46）和 1.10（0.39-1.56），分别 vs 1.19（0.65-1.84），P<0.05）。通过 logistic 回归分析生成不同的组合模型，固定假阳性率为 10%时，早发型和晚发型子痫前期的检出率分别为 47%和 29%。
随后发生早发型或晚发型子痫前期的妊娠，其特点是妊娠早期胎盘功能障碍和抗血管生成状态。包括母体特征、UtA 多普勒和 PlGF 的回归模型可明显预测约一半将发生早发型子痫前期的妊娠。我们认为，需要在多个领域进行更多研究，以帮助开发一种更好、更适合人群的妊娠早期子痫前期筛查试验。
