Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Obstetrics and Gynecology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
BMJ Open. 2021 Aug 13;11(8):e046161. doi: 10.1136/bmjopen-2020-046161.
Previous studies suggested mean arterial pressure (MAP) had moderate predictive values in the first and second trimesters for the prediction of preeclampsia. However, the performance of MAP in Asian women is still unclear. The objective of this study was to examine the predictive values of MAP in Asian population throughout gestation, and to compare the performance of MAP, angiogenic factors and uterine artery Doppler in the prediction of preeclampsia.
A prospective cohort study.
KK Women's and Children's Hospital, Singapore.
A total of 926 women with singleton pregnancy less than 14 weeks of gestation were included in the prospective Neonatal and Obstetrics Risks Assessment cohort between September 2010 and October 2014. Maternal blood pressure levels, uterine artery pulsatility index (UtA-PI), serum soluble fms-like tyrosine kinase 1 (sFlt-1), placental growth factor (PlGF) and sFlt-1/PlGF ratio were measured at 11-14, 18-22, 28-32 and 34 weeks onward, respectively.
Preeclampsia was the main pregnancy outcome.
A total of 20 women developed preeclampsia, who had significantly lower levels of PlGF, higher levels of sFlt-1/PlGF ratio and MAP throughout pregnancy than women without preeclampsia. Compared with angiogenic factors and UtA-PI, MAP had significantly higher area under the receiver operating characteristic curves (AUCs) for predicting preeclampsia and term preeclampsia throughout gestation. For predicting preeclampsia, MAP had AUCs of 0.86 (95% CI 0.78 to 0.95), 0.87 (95% CI 0.80 to 0.95) and 0.91 (95% CI 0.85 to 0.98) at 11-14, 18-22 and 28-32 weeks, respectively. For predicting term preeclampsia, MAP yielded AUCs of 0.87 (95% CI 0.75 to 0.99), 0.87 (95% CI 0.76 to 0.98) and 0.90 (95% CI 0.80 to 0.99) at 11-14, 18-22 and 28-32 weeks, respectively. For predicting preterm preeclampsia, the performance of MAP and PlGF was similar.
MAP is a good predictor for preeclampsia, especially term preeclampsia, in Asian women.
既往研究表明，在妊娠 1 至 2 期，平均动脉压（MAP）对预测子痫前期具有中等预测价值。然而，MAP 在亚洲女性中的表现仍不清楚。本研究旨在检验 MAP 在整个孕期对亚洲人群的预测价值，并比较 MAP、血管生成因子和子宫动脉多普勒在子痫前期预测中的表现。
前瞻性队列研究。
新加坡 KK 妇女儿童医院。
2010 年 9 月至 2014 年 10 月期间，纳入了共 926 名小于 14 周妊娠的单胎妊娠的孕妇，参与前瞻性新生儿和产科风险评估队列。在 11-14、18-22、28-32 和 34 周时，分别测量了孕妇的血压水平、子宫动脉搏动指数（UtA-PI）、血清可溶性 fms 样酪氨酸激酶 1（sFlt-1）、胎盘生长因子（PlGF）和 sFlt-1/PlGF 比值。
子痫前期是主要的妊娠结局。
共有 20 名孕妇发生子痫前期，与无子痫前期的孕妇相比，她们在整个孕期的 PlGF 水平显著降低，sFlt-1/PlGF 比值和 MAP 水平显著升高。与血管生成因子和 UtA-PI 相比，MAP 对预测子痫前期和足月子痫前期的受试者工作特征曲线（ROC）下面积（AUC）具有显著更高的 AUC。对于预测子痫前期，MAP 在 11-14、18-22 和 28-32 周的 AUC 分别为 0.86（95%CI 0.78 至 0.95）、0.87（95%CI 0.80 至 0.95）和 0.91（95%CI 0.85 至 0.98）。对于预测足月子痫前期，MAP 在 11-14、18-22 和 28-32 周的 AUC 分别为 0.87（95%CI 0.75 至 0.99）、0.87（95%CI 0.76 至 0.98）和 0.90（95%CI 0.80 至 0.99）。对于预测早产子痫前期，MAP 和 PlGF 的表现相似。
MAP 是预测亚洲女性子痫前期，尤其是足月子痫前期的良好指标。
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