Accuracy of competing-risks model in screening for pre-eclampsia by maternal factors and biomarkers at 11-13 weeks' gestation

Ultrasound Obstet Gynecol. 2017 Jun;49(6):751-755. doi: 10.1002/uog.17399. Epub 2017 May 14.

Abstract

Objective: To examine the diagnostic accuracy of a previously developed model for prediction of pre-eclampsia (PE) by a combination of maternal factors and biomarkers at 11-13 weeks' gestation.

Methods: This was a prospective first-trimester multicenter study of screening for PE in 8775 singleton pregnancies. A previously published algorithm was used for the calculation of patient-specific risk of PE in each individual. The detection rates (DRs) and false-positive rates (FPRs) for delivery with PE < 32, < 37 and ≥ 37 weeks were estimated and compared with those for the dataset used for development of the algorithm.

Results: In the study population, 239 (2.7%) cases developed PE, of which 17 (0.2%), 59 (0.7%) and 180 (2.1%) developed PE < 32, < 37 and ≥ 37 weeks, respectively. With combined screening by maternal factors, mean arterial pressure, uterine artery pulsatility index and serum placental growth factor, the DR was 100% (95% CI, 80-100%) for PE < 32 weeks, 75% (95% CI, 62-85%) for PE < 37 weeks and 43% (95% CI, 35-50%) for PE ≥ 37 weeks, at a 10% FPR. These DRs were similar to the estimated rates for the dataset used for development of the model: 89% (95% CI, 79-96%) for PE < 32 weeks, 75% (95% CI, 70-80%) for PE < 37 weeks and 47% (95% CI, 44-51%) for PE ≥ 37 weeks.

Conclusion: Assessment of a combination of maternal factors and biomarkers at 11-13 weeks provides effective first-trimester screening for preterm PE. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Keywords: Bayes' theorem; first-trimester screening; mean arterial pressure; placental growth factor; pre-eclampsia; pregnancy-associated plasma protein-A; pyramid of pregnancy care; survival model; uterine artery Doppler.

Publication types

  • Evaluation Study
  • Multicenter Study

MeSH terms

  • Adult
  • Biomarkers / blood*
  • Europe
  • Female
  • Gestational Age
  • Humans
  • Models, Theoretical
  • Placenta Growth Factor / blood*
  • Pre-Eclampsia / blood
  • Pre-Eclampsia / diagnosis*
  • Pregnancy
  • Pregnancy Trimester, First
  • Prenatal Diagnosis*
  • Prospective Studies
  • Pulsatile Flow
  • Risk Assessment
  • Sensitivity and Specificity
  • Uterine Artery / physiology*

Substances

  • Biomarkers
  • Placenta Growth Factor