Kuc S, Koster M P, Franx A, Schielen P C, Visser G H
Department of Obstetrics, University Medical Centre Utrecht, Location WKZ, Utrecht, Netherlands.
Laboratory for Infectious Diseases and Screening, National Institute for Public Health and the Environment, Bilthoven, Netherlands.
Pregnancy Hypertens. 2012 Jul;2(3):225-6. doi: 10.1016/j.preghy.2012.04.088. Epub 2012 Jun 13.
In a previous study, we described the predictive value of first-trimester pregnancy-associated plasma protein-A (PAPP-A), free beta-subunit of human chorionic gonadotrophin (fb-hCG), Placental Growth Factor (PlGF) and A Desintegrin And Metalloproteinase 12 (ADAM12) for early onset preeclampsia (delivery <34 weeks) [1].
The objective of the current study was to obtain the predictive value of these serum makers, for both early onset PE (EOPE) and late onset PE (LOPE), combined with maternal characteristics and first-trimester maternal mean arterial blood pressure (MAP).
This was a nested case-control study, using stored first-trimester maternal serum from 167 women who subsequently developed PE, and 500 uncomplicated singleton pregnancies which resulted in a live birth =>37 weeks. Maternal characteristics (i.e. medical records, parity, weight, length) MAP and pregnancy outcome (i.e. gestational age at delivery, birthweight, fetal sex) were collected for each individual and used to calculate prior risks for PE in a multiple logistic regression model. MAP values and marker levels of PAPP-A, fb-hCG, PlGF and ADAM12 were expressed as multiples of the gestation-specific normal median (MoMs). Subsequently, MoMs were log-transformed and compared between PE and controls using Student's t-tests. Posterior risks were calculated using different combinations of variables;(1) maternal characteristics, serum markers, and MAP separately (2) maternal characteristics combined with serum markers or MAP (3) maternal characteristics combined with serum markers and MAP. The model-predicted detection rates (DR) for fixed 10% false-positive rates were obtained for EOPE and LOPE with or without intra-uterine growth restriction (IUGR,birth weight <10th centile).
The maternal characteristics: maternal age, weight, length, smoking status and nulliparity were discriminative between PE and control groups and therefore incorporated in the multiple logistic regression model. MoM MAP was significantly elevated (1.10 p<0.001; 1.07 p<0.001) and MoM PlGF was significantly reduced (0.95 p=0.016; 0.90 p=0.029) in the EOPE and LOPE group, respectively. The differences in markers for IUGR groups were larger. The estimated DRs of the three different models are presented in the table.
This study demonstrates that first-trimester MAP and PlGF combined with maternal characteristics are promising markers in risk assessment for PE. Combination of markers proved especially useful for risk assessment for term PE. Detection rates were higher in the presence of IUGR.
