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Nguyen-Hoang L, Sahota DS, Pooh RK, Duan H, Chaiyasit N, Sekizawa A, Shaw SW, Seshadri S, Choolani M, Yapan P, Sim WS, Ma R, Leung WC, Lau SL, Lee NMW, Leung HYH, Meshali T, Meiri H, Louzoun Y, Poon LC. Validation of the first-trimester machine learning model for predicting pre-eclampsia in an Asian population. Int J Gynaecol Obstet 2024; 167:350-359. [PMID: 38666305 DOI: 10.1002/ijgo.15563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/07/2024] [Accepted: 04/16/2024] [Indexed: 09/25/2024]
Abstract
OBJECTIVES To evaluate the performance of an artificial intelligence (AI) and machine learning (ML) model for first-trimester screening for pre-eclampsia in a large Asian population. METHODS This was a secondary analysis of a multicenter prospective cohort study in 10 935 participants with singleton pregnancies attending for routine pregnancy care at 11-13+6 weeks of gestation in seven regions in Asia between December 2016 and June 2018. We applied the AI+ML model for the first-trimester prediction of preterm pre-eclampsia (<37 weeks), term pre-eclampsia (≥37 weeks), and any pre-eclampsia, which was derived and tested in a cohort of pregnant participants in the UK (Model 1). This model comprises maternal factors with measurements of mean arterial pressure, uterine artery pulsatility index, and serum placental growth factor (PlGF). The model was further retrained with adjustments for analyzers used for biochemical testing (Model 2). Discrimination was assessed by area under the receiver operating characteristic curve (AUC). The Delong test was used to compare the AUC of Model 1, Model 2, and the Fetal Medicine Foundation (FMF) competing risk model. RESULTS The predictive performance of Model 1 was significantly lower than that of the FMF competing risk model in the prediction of preterm pre-eclampsia (0.82, 95% confidence interval [CI] 0.77-0.87 vs. 0.86, 95% CI 0.811-0.91, P = 0.019), term pre-eclampsia (0.75, 95% CI 0.71-0.80 vs. 0.79, 95% CI 0.75-0.83, P = 0.006), and any pre-eclampsia (0.78, 95% CI 0.74-0.81 vs. 0.82, 95% CI 0.79-0.84, P < 0.001). Following the retraining of the data with adjustments for the PlGF analyzers, the performance of Model 2 for predicting preterm pre-eclampsia, term pre-eclampsia, and any pre-eclampsia was improved with the AUC values increased to 0.84 (95% CI 0.80-0.89), 0.77 (95% CI 0.73-0.81), and 0.80 (95% CI 0.76-0.83), respectively. There were no differences in AUCs between Model 2 and the FMF competing risk model in the prediction of preterm pre-eclampsia (P = 0.135) and term pre-eclampsia (P = 0.084). However, Model 2 was inferior to the FMF competing risk model in predicting any pre-eclampsia (P = 0.024). CONCLUSION This study has demonstrated that following adjustment for the biochemical marker analyzers, the predictive performance of the AI+ML prediction model for pre-eclampsia in the first trimester was comparable to that of the FMF competing risk model in an Asian population.
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Affiliation(s)
- Long Nguyen-Hoang
- Department of Obstetrics and Gynecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR
| | - Daljit S Sahota
- Department of Obstetrics and Gynecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR
| | | | | | | | | | | | | | | | | | - Wen Shan Sim
- Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore
| | - Runmei Ma
- First Affiliated Hospital of Kunming Medical University, Kunming, China
| | | | - So Ling Lau
- Department of Obstetrics and Gynecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR
| | - Nikki May Wing Lee
- Department of Obstetrics and Gynecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR
| | - Hiu Yu Hillary Leung
- Department of Obstetrics and Gynecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR
| | - Tal Meshali
- Department of Mathematics, Bar Ilan University, Ramat Gan, Israel
| | - Hamutal Meiri
- The ASPRE Consortium and TeleMarpe, Tel Aviv, Israel
| | - Yoram Louzoun
- Department of Mathematics, Bar Ilan University, Ramat Gan, Israel
| | - Liona C Poon
- Department of Obstetrics and Gynecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR
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Lu YT, Chen CP, Sun FJ, Chen YY, Wang LK, Chen CY. Associations between first-trimester screening biomarkers and maternal characteristics with gestational diabetes mellitus in Chinese women. Front Endocrinol (Lausanne) 2024; 15:1383706. [PMID: 39175575 PMCID: PMC11339418 DOI: 10.3389/fendo.2024.1383706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 07/26/2024] [Indexed: 08/24/2024] Open
Abstract
Background Gestational diabetes mellitus (GDM) can result in adverse maternal and neonatal outcomes. Predicting those at high risk of GDM and early interventions can reduce the development of GDM. The aim of this study was to examine the associations between first-trimester prenatal screening biomarkers and maternal characteristics in relation to GDM in Chinese women. Methods We conducted a retrospective cohort study of singleton pregnant women who received first-trimester aneuploidy and preeclampsia screening between January 2019 and May 2021. First-trimester prenatal screening biomarkers, including pregnancy-associated plasma protein A (PAPP-A), free beta-human chorionic gonadotropin, and placental growth factor (PLGF), along with maternal characteristics, were collected for analysis in relation to GDM. Receiver operating characteristic (ROC) curve and logistic regression analyses were used to evaluate variables associated with GDM. Results Of the 1452 pregnant women enrolled, 96 developed GDM. PAPP-A (5.01 vs. 5.73 IU/L, P < 0.001) and PLGF (39.88 vs. 41.81 pg/mL, P = 0.044) were significantly lower in the GDM group than in the non-GDM group. The area under the ROC curve of combined maternal characteristics and biomarkers was 0.73 (95% confidence interval [CI] 0.68-0.79, P < 0.001). The formula for predicting GDM was as follows: P = 1/[1 + exp (-8.148 + 0.057 x age + 0.011 x pregestational body mass index + 1.752 x previous GDM history + 0.95 x previous preeclampsia history + 0.756 x family history of diabetes + 0.025 x chronic hypertension + 0.036 x mean arterial pressure - 0.09 x PAPP-A - 0.001 x PLGF)]. Logistic regression analysis revealed that higher pregestational body mass index (adjusted odds ratio [aOR] 1.03, 95% CI 1.01 - 1.06, P = 0.012), previous GDM history (aOR 9.97, 95% CI 3.92 - 25.37, P < 0.001), family history of diabetes (aOR 2.36, 95% CI 1.39 - 4.02, P = 0.001), higher mean arterial pressure (aOR 1.17, 95% CI 1.07 - 1.27, P < 0.001), and lower PAPP-A level (aOR 0.91, 95% CI 0.83 - 1.00, P = 0.040) were independently associated with the development of GDM. The Hosmer-Lemeshow test demonstrated that the model exhibited an excellent discrimination ability (chi-square = 3.089, df = 8, P = 0.929). Conclusion Downregulation of first-trimester PAPP-A and PLGF was associated with the development of GDM. Combining first-trimester biomarkers with maternal characteristics could be valuable for predicting the risk of GDM.
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Affiliation(s)
- Yu-Ting Lu
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chie-Pein Chen
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Fang-Ju Sun
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
| | - Yi-Yung Chen
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Liang-Kai Wang
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chen-Yu Chen
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, Taipei, Taiwan
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Guerby P, Audibert F, Johnson JA, Okun N, Giguère Y, Forest JC, Chaillet N, Mâsse B, Wright D, Ghesquiere L, Bujold E. Prospective Validation of First-Trimester Screening for Preterm Preeclampsia in Nulliparous Women (PREDICTION Study). Hypertension 2024; 81:1574-1582. [PMID: 38708601 DOI: 10.1161/hypertensionaha.123.22584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/05/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Fetal Medicine Foundation (FMF) studies suggest that preterm preeclampsia can be predicted in the first trimester by combining biophysical, biochemical, and ultrasound markers and prevented using aspirin. We aimed to evaluate the FMF preterm preeclampsia screening test in nulliparous women. METHODS We conducted a prospective multicenter cohort study of nulliparous women recruited at 11 to 14 weeks. Maternal characteristics, mean arterial blood pressure, PAPP-A (pregnancy-associated plasma protein A), PlGF (placental growth factor) in maternal blood, and uterine artery pulsatility index were collected at recruitment. The risk of preterm preeclampsia was calculated by a third party blinded to pregnancy outcomes. Receiver operating characteristic curves were used to estimate the detection rate (sensitivity) and the false-positive rate (1-specificity) for preterm (<37 weeks) and for early-onset (<34 weeks) preeclampsia according to the FMF screening test and according to the American College of Obstetricians and Gynecologists criteria. RESULTS We recruited 7554 participants including 7325 (97%) who remained eligible after 20 weeks of which 65 (0.9%) developed preterm preeclampsia, and 22 (0.3%) developed early-onset preeclampsia. Using the FMF algorithm (cutoff of ≥1 in 110 for preterm preeclampsia), the detection rate was 63.1% for preterm preeclampsia and 77.3% for early-onset preeclampsia at a false-positive rate of 15.8%. Using the American College of Obstetricians and Gynecologists criteria, the equivalent detection rates would have been 61.5% and 59.1%, respectively, for a false-positive rate of 34.3%. CONCLUSIONS The first-trimester FMF preeclampsia screening test predicts two-thirds of preterm preeclampsia and three-quarters of early-onset preeclampsia in nulliparous women, with a false-positive rate of ≈16%. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT02189148.
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Affiliation(s)
- Paul Guerby
- Reproduction, Mother and Child Health Unit, CHU De Québec-Université Laval Research Center (P.G., Y.G., J.-C.F., N.C., L.G., E.B.), Université Laval, Canada
- Department of Gynecology and Obstetrics, Infinity CNRS, Inserm UMR 1291, CHU Toulouse, France (P.G.)
| | - Francois Audibert
- Department of Obstetrics and Gynecology, CHU Ste-Justine Research Center, Université de Montréal, Canada (F.A.)
| | - Jo-Ann Johnson
- Department of Obstetrics and Gynaecology, University of Calgary, AB, Canada (J.-A.J.)
| | - Nanette Okun
- Department of Obstetrics and Gynaecology, University of Toronto, ON, Canada (N.O.)
| | - Yves Giguère
- Reproduction, Mother and Child Health Unit, CHU De Québec-Université Laval Research Center (P.G., Y.G., J.-C.F., N.C., L.G., E.B.), Université Laval, Canada
- Department of Molecular Biology, Medical Biochemistry and Pathology (Y.G., J.-C.F.), Université Laval, Canada
| | - Jean-Claude Forest
- Reproduction, Mother and Child Health Unit, CHU De Québec-Université Laval Research Center (P.G., Y.G., J.-C.F., N.C., L.G., E.B.), Université Laval, Canada
- Department of Molecular Biology, Medical Biochemistry and Pathology (Y.G., J.-C.F.), Université Laval, Canada
| | - Nils Chaillet
- Reproduction, Mother and Child Health Unit, CHU De Québec-Université Laval Research Center (P.G., Y.G., J.-C.F., N.C., L.G., E.B.), Université Laval, Canada
| | - Benoit Mâsse
- École de Santé Publique de l'Université de Montréal, QC, Canada (B.M.)
| | - David Wright
- École de Santé Publique de l'Université de Montréal, QC, Canada (B.M.)
- Institute of Health Research, University of Exeter, United Kingdom (D.W.)
| | - Louise Ghesquiere
- Reproduction, Mother and Child Health Unit, CHU De Québec-Université Laval Research Center (P.G., Y.G., J.-C.F., N.C., L.G., E.B.), Université Laval, Canada
- Department of Obstetrics, Université de Lille, CHU de Lille, France (L.G.)
| | - Emmanuel Bujold
- Reproduction, Mother and Child Health Unit, CHU De Québec-Université Laval Research Center (P.G., Y.G., J.-C.F., N.C., L.G., E.B.), Université Laval, Canada
- Department of Gynecology, Obstetrics and Reproduction (E.B.), Université Laval, Canada
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Ip PNP, Nguyen-Hoang L, Chaemsaithong P, Guo J, Wang X, Sahota DS, Chung JPW, Poon LCY. Ultrasonographic placental parameters at 11-13+6 weeks' gestation in the prediction of complications in pregnancy after assisted reproductive technology. Taiwan J Obstet Gynecol 2024; 63:341-349. [PMID: 38802197 DOI: 10.1016/j.tjog.2023.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2023] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVE To evaluate the performance of maternal factors, biophysical and biochemical markers at 11-13 + 6 weeks' gestation in the prediction of gestational diabetes mellitus with or without large for gestational age (GDM ± LGA) fetus and great obstetrical syndromes (GOS) among singleton pregnancy following in-vitro fertilisation (IVF)/embryo transfer (ET). MATERIALS AND METHODS A prospective cohort study was conducted between December 2017 and January 2020 including patients who underwent IVF/ET. Maternal mean arterial pressure (MAP), ultrasound markers including placental volume, vascularisation index (VI), flow index (FI) and vascularisation flow index (VFI), mean uterine artery pulsatility index (mUtPI) and biochemical markers including placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) were measured at 11-13 + 6 weeks' gestation. Logistic regression analysis was performed to determine the significant predictors of complications. RESULTS Among 123 included pregnancies, 38 (30.9%) had GDM ± LGA fetus and 28 (22.8%) had GOS. The median maternal height and body mass index were significantly higher in women with GDM ± LGA fetus. Multivariate logistic regression analysis demonstrated that in the prediction of GDM ± LGA fetus and GOS, there were significant independent contributions from FI MoM (area under curve (AUROC) of 0.610, 95% CI 0.492-0.727; p = 0.062) and MAP MoM (AUROC of 0.645, 95% CI 0.510-0.779; p = 0.026), respectively. CONCLUSION FI and MAP are independent predictors for GDM ± LGA fetus and GOS, respectively. However, they have low predictive value. There is a need to identify more specific novel biomarkers in differentiating IVF/ET pregnancies that are at a higher risk of developing complications.
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Affiliation(s)
- Patricia Nga Ping Ip
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Long Nguyen-Hoang
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Piya Chaemsaithong
- Department of Obstetrics and Gynecology, Mahidol University, Bangkok, Thailand
| | - Jun Guo
- Department of Obstetrics and Gynaecology, Beijing Tongren Hospital, The Capital Medical University, Beijing, China
| | - Xueqin Wang
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Daljit Singh Sahota
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jacqueline Pui Wah Chung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Liona Chiu Yee Poon
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China.
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Ohkuchi A, Takahashi K, Hirashima C, Suzuki H, Takahashi H, Nagayama S, Ogoyama M, Horie K, Usui R, Fujiwara H. Automated electrochemiluminescence immunoassay for serum PlGF levels in women with singleton pregnancy at 9-13 weeks of gestation predicts preterm preeclampsia: a retrospective cohort study. Hypertens Res 2024; 47:1196-1207. [PMID: 38135845 DOI: 10.1038/s41440-023-01534-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 10/27/2023] [Accepted: 11/15/2023] [Indexed: 12/24/2023]
Abstract
Our aims were to obtain the gestational-age-specific median of common logarithmic placental growth factor (PlGF) values in the first trimester in women with a singleton pregnancy in order to generate the gestational-age-specific multiple of the median (MoM) of log10PlGF at 9-13 weeks of gestation, to evaluate screening parameters of MoM of log10PlGF at 9-13 weeks of gestation to predict preterm preeclampsia (PE), and to construct an appropriate prediction model for preterm PE using minimum risk factors in multivariable logistic regression analyses in a retrospective sub-cohort study. Preterm PE occurred in 2.9% (20/700), and PE in 5.1% (36/700). Serum PlGF levels were measured using Elecsys PlGF®. MoMs of log10PlGF at 9-13 weeks of gestation in Japanese women with a singleton pregnancy followed a normal distribution. We determined the appropriate cut-off value of MoM of log10PlGF to predict preterm PE at around a10% false-positive rate (0.854). The MoM of log10PlGF < 0.854 yielded sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio (95% confidence interval [CI]), and negative likelihood ratio (95% CI) of 55.0%, 91.9%, 17.5%, 98.5%, 6.79 (4.22-10.91), and 0.49 (0.30-0.80), respectively. The combination of MoM of log10PlGF and presence of either chronic hypertension or history of PE/gestational hypertension (GH) yielded sensitivity and specificity of 80.0 and 85.7%, respectively, to predict preterm PE. In conclusion, the automated electrochemiluminescence immunoassay for serum PlGF levels in women with singleton pregnancy at 9-13 weeks of gestation may be useful to predict preterm PE.
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Affiliation(s)
- Akihide Ohkuchi
- Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine, Shimotsuke-shi, Tochigi, 329-0498, Japan.
| | - Kayo Takahashi
- Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine, Shimotsuke-shi, Tochigi, 329-0498, Japan
| | - Chikako Hirashima
- Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine, Shimotsuke-shi, Tochigi, 329-0498, Japan
| | - Hirotada Suzuki
- Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine, Shimotsuke-shi, Tochigi, 329-0498, Japan
| | - Hironori Takahashi
- Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine, Shimotsuke-shi, Tochigi, 329-0498, Japan
| | - Shiho Nagayama
- Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine, Shimotsuke-shi, Tochigi, 329-0498, Japan
| | - Manabu Ogoyama
- Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine, Shimotsuke-shi, Tochigi, 329-0498, Japan
| | - Kenji Horie
- Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine, Shimotsuke-shi, Tochigi, 329-0498, Japan
| | - Rie Usui
- Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine, Shimotsuke-shi, Tochigi, 329-0498, Japan
| | - Hiroyuki Fujiwara
- Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine, Shimotsuke-shi, Tochigi, 329-0498, Japan
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Nguyen-Hoang L, Papastefanou I, Sahota DS, Pooh RK, Zheng M, Chaiyasit N, Tokunaka M, Shaw SW, Seshadri S, Choolani M, Yapan P, Sim WS, Poon LC. Evaluation of screening performance of first-trimester competing-risks prediction model for small-for-gestational age in Asian population. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 63:331-341. [PMID: 37552550 DOI: 10.1002/uog.27447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 06/17/2023] [Accepted: 07/21/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVE To examine the external validity of the Fetal Medicine Foundation (FMF) competing-risks model for the prediction of small-for-gestational age (SGA) at 11-14 weeks' gestation in an Asian population. METHODS This was a secondary analysis of a multicenter prospective cohort study in 10 120 women with a singleton pregnancy undergoing routine assessment at 11-14 weeks' gestation. We applied the FMF competing-risks model for the first-trimester prediction of SGA, combining maternal characteristics and medical history with measurements of mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI) and serum placental growth factor (PlGF) concentration. We calculated risks for different cut-offs of birth-weight percentile (< 10th , < 5th or < 3rd percentile) and gestational age at delivery (< 37 weeks (preterm SGA) or SGA at any gestational age). Predictive performance was examined in terms of discrimination and calibration. RESULTS The predictive performance of the competing-risks model for SGA was similar to that reported in the original FMF study. Specifically, the combination of maternal factors with MAP, UtA-PI and PlGF yielded the best performance for the prediction of preterm SGA with birth weight < 10th percentile (SGA < 10th ) and preterm SGA with birth weight < 5th percentile (SGA < 5th ), with areas under the receiver-operating-characteristics curve (AUCs) of 0.765 (95% CI, 0.720-0.809) and 0.789 (95% CI, 0.736-0.841), respectively. Combining maternal factors with MAP and PlGF yielded the best model for predicting preterm SGA with birth weight < 3rd percentile (SGA < 3rd ) (AUC, 0.797 (95% CI, 0.744-0.850)). After excluding cases with pre-eclampsia, the combination of maternal factors with MAP, UtA-PI and PlGF yielded the best performance for the prediction of preterm SGA < 10th and preterm SGA < 5th , with AUCs of 0.743 (95% CI, 0.691-0.795) and 0.762 (95% CI, 0.700-0.824), respectively. However, the best model for predicting preterm SGA < 3rd without pre-eclampsia was the combination of maternal factors and PlGF (AUC, 0.786 (95% CI, 0.723-0.849)). The FMF competing-risks model including maternal factors, MAP, UtA-PI and PlGF achieved detection rates of 42.2%, 47.3% and 48.1%, at a fixed false-positive rate of 10%, for the prediction of preterm SGA < 10th , preterm SGA < 5th and preterm SGA < 3rd , respectively. The calibration of the model was satisfactory. CONCLUSION The screening performance of the FMF first-trimester competing-risks model for SGA in a large, independent cohort of Asian women is comparable with that reported in the original FMF study in a mixed European population. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- L Nguyen-Hoang
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - I Papastefanou
- Fetal Medicine Research Institute, King's College Hospital, London, UK
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - D S Sahota
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - R K Pooh
- CRIFM Prenatal Medical Clinic, Osaka, Japan
| | - M Zheng
- Center for Obstetrics and Gynecology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - N Chaiyasit
- Department of Obstetrics and Gynecology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - M Tokunaka
- Department of Obstetrics and Gynecology, Showa University Hospital, Tokyo, Japan
| | - S W Shaw
- Department of Obstetrics and Gynecology, Taipei Chang Gung Memorial Hospital, Taipei, Taiwan
| | | | - M Choolani
- Department of Obstetrics and Gynecology, National University Hospital, Singapore
| | - P Yapan
- Faculty of Medicine, Siriraj Hospital, Bangkok, Thailand
| | - W S Sim
- Maternal-Fetal Medicine, KK Women's and Children's Hospital, Singapore
| | - L C Poon
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
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Moungmaithong S, Wang X, Lau CSL, Tse AWT, Lee NMW, Leung HHY, Poon LC, Sahota DS. Glycosylated fibronectin improves first-trimester prediction of pre-eclampsia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:512-521. [PMID: 37616523 DOI: 10.1002/uog.27451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/23/2023] [Accepted: 07/24/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVE To determine whether maternal serum glycosylated fibronectin (GlyFn) level in the first trimester increases the sensitivity of the Fetal Medicine Foundation (FMF) triple test, which incorporates mean arterial pressure, uterine artery pulsatility index and placental growth factor, when screening for pre-eclampsia (PE) in an Asian population. METHODS This was a nested case-control study of Chinese women with a singleton pregnancy who were screened for PE at 11-13 weeks' gestation as part of a non-intervention study between December 2016 and June 2018. GlyFn levels were measured retrospectively in archived serum from 1685 pregnancies, including 101 with PE, using an enzyme-linked immunosorbent assay (ELISA), and from 448 pregnancies, including 101 with PE, using a point-of-care (POC) device. Concordance between ELISA and POC tests was assessed using Lin's correlation coefficient and Passing-Bablok and Bland-Altman analyses. GlyFn was transformed into multiples of the median (MoM) to adjust for maternal and pregnancy characteristics. GlyFn MoM was compared between PE and non-PE pregnancies, and the association between GlyFn MoM and gestational age at delivery with PE was assessed. Risk for developing PE was estimated using the FMF competing-risks model. Screening performance for preterm and any-onset PE using different biomarker combinations was quantified by area under the receiver-operating-characteristics curve (AUC) and detection rate (DR) at a 10% fixed false-positive rate (FPR). Differences in AUC between biomarker combinations were compared using the DeLong test. RESULTS The concordance correlation coefficient between ELISA and POC measurements was 0.86 (95% CI, 0.83-0.88). Passing-Bablok analysis indicated proportional bias (slope, 1.08 (95% CI, 1.04-1.14)), with POC GlyFn being significantly higher compared with ELISA GlyFn. ELISA GlyFn in non-PE pregnancies was independent of gestational age at screening (P = 0.11), but significantly dependent on maternal age (P < 0.003), weight (P < 0.0002), height (P = 0.001), parity (P < 0.02) and smoking status (P = 0.002). Compared with non-PE pregnancies, median GlyFn MoM using ELISA and POC testing was elevated significantly in those with preterm PE (1.23 vs 1.00; P < 0.0001 and 1.18 vs 1.00; P < 0.0001, respectively) and those with term PE (1.26 vs 1.00; P < 0.0001 and 1.22 vs 1.00; P < 0.0001, respectively). GlyFn MoM was not correlated with gestational age at delivery with PE (P = 0.989). Adding GlyFn to the FMF triple test for preterm PE increased significantly the AUC from 0.859 to 0.896 (P = 0.012) and increased the DR at 10% FPR from 64.9% (95% CI, 48.7-81.1%) to 82.9% (95% CI, 66.4-93.4%). The corresponding DRs at 10% FPR for any-onset PE were 52.5% (95% CI, 42.3-62.5%) and 65.4% (95% CI, 55.2-74.5%), respectively. CONCLUSIONS Adding GlyFn to the FMF triple test increased the screening sensitivity for both preterm and any-onset PE in an Asian population. Prospective non-intervention studies are needed to confirm these initial findings. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- S Moungmaithong
- Department of Obstetrics and Gynaecology, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - X Wang
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - C S L Lau
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - A W T Tse
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Hong Kong, SAR, China
| | - N M W Lee
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - H H Y Leung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - L C Poon
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, SAR, China
- Shenzhen Research Institute, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - D S Sahota
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, SAR, China
- Shenzhen Research Institute, The Chinese University of Hong Kong, Hong Kong, SAR, China
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Cuenca-Gómez D, de Paco Matallana C, Rolle V, Valiño N, Revello R, Adiego B, Mendoza M, Molina FS, Carrillo MP, Delgado JL, Wright A, Santacruz B, Gil MM. Performance of first-trimester combined screening for preterm pre-eclampsia: findings from cohort of 10 110 pregnancies in Spain. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:522-530. [PMID: 37099759 DOI: 10.1002/uog.26233] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 04/05/2023] [Accepted: 04/13/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of the Fetal Medicine Foundation (FMF) competing-risks model, incorporating maternal characteristics, mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI) and placental growth factor (PlGF) (the 'triple test'), for the prediction at 11-13 weeks' gestation of preterm pre-eclampsia (PE) in a Spanish population. METHODS This was a prospective cohort study performed in eight fetal medicine units in five different regions of Spain between September 2017 and December 2019. All pregnant women with a singleton pregnancy and a non-malformed live fetus attending a routine ultrasound examination at 11 + 0 to 13 + 6 weeks' gestation were invited to participate. Maternal demographic characteristics and medical history were recorded and MAP, UtA-PI, serum PlGF and pregnancy-associated plasma protein-A (PAPP-A) were measured following standardized protocols. Treatment with aspirin during pregnancy was also recorded. Raw values of biomarkers were converted into multiples of the median (MoM), and audits were performed periodically to provide regular feedback to operators and laboratories. Patient-specific risks for term and preterm PE were calculated according to the FMF competing-risks model, blinded to pregnancy outcome. The performance of screening for PE, taking into account aspirin use, was assessed by calculating the area under the receiver-operating-characteristics curve (AUC) and detection rate (DR) at a 10% fixed screen-positive rate (SPR). Risk calibration of the model was assessed. RESULTS The study population comprised 10 110 singleton pregnancies, including 72 (0.7%) that developed preterm PE. In the preterm PE group, compared to those without PE, median MAP MoM and UtA-PI MoM were significantly higher, and median serum PlGF MoM and PAPP-A MoM were significantly lower. In women with PE, the deviation from normal in all biomarkers was inversely related to gestational age at delivery. Screening for preterm PE by a combination of maternal characteristics and medical history with MAP, UtA-PI and PlGF had a DR, at 10% SPR, of 72.7% (95% CI, 62.9-82.6%). An alternative strategy of replacing PlGF with PAPP-A in the triple test was associated with poorer screening performance for preterm PE, giving a DR of 66.5% (95% CI, 55.8-77.2%). The calibration plot showed good agreement between predicted risk and observed incidence of preterm PE, with a slope of 0.983 (95% CI, 0.846-1.120) and an intercept of 0.154 (95% CI, -0.091 to 0.397). CONCLUSIONS The FMF model is effective in predicting preterm PE in the Spanish population at 11-13 weeks' gestation. This method of screening is feasible to implement in routine clinical practice, but it should be accompanied by a robust audit and monitoring system, in order to maintain high-quality screening. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- D Cuenca-Gómez
- Department of Obstetrics and Gynecology, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain
- Faculty of Medicine, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - C de Paco Matallana
- Department of Obstetrics and Gynecology, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
- Institute for Biomedical Research of Murcia, IMIB-Arrixaca, El Palmar, Murcia, Spain
| | - V Rolle
- Department of Obstetrics and Gynecology, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain
- Biostatistics and Epidemiology Platform, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - N Valiño
- Department of Obstetrics and Gynecology, Complejo Hospitalario Universitario A Coruña, A Coruña, Galicia, Spain
| | - R Revello
- Department of Obstetrics and Gynecology, Hospital Universitario Quirón, Pozuelo de Alarcón, Madrid, Spain
| | - B Adiego
- Department of Obstetrics and Gynecology, Hospital Universitario Fundación de Alcorcón, Alcorcón, Madrid, Spain
| | - M Mendoza
- Department of Obstetrics and Gynecology, Hospital Universitario Vall d'Hebrón, Barcelona, Catalonia, Spain
| | - F S Molina
- Department of Obstetrics and Gynecology, Hospital Clínico Universitario San Cecilio, Granada, Spain
- Instituto de Investigación Biosanitaria (Ibs.GRANADA), Granada, Spain
| | - M P Carrillo
- Department of Obstetrics and Gynecology, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - J L Delgado
- Department of Obstetrics and Gynecology, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - A Wright
- Institute of Health Research, University of Exeter, Exeter, UK
| | - B Santacruz
- Department of Obstetrics and Gynecology, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain
- Faculty of Medicine, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - M M Gil
- Department of Obstetrics and Gynecology, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain
- Faculty of Medicine, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
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Trottmann F, Challande P, Manegold-Brauer G, Ardabili S, Hösli I, Schönberger H, Amylidi-Mohr S, Kohl J, Hodel M, Surbek D, Raio L, Mosimann B. Implementing Preeclampsia Screening in Switzerland (IPSISS): First Results from a Multicentre Registry. Fetal Diagn Ther 2023; 50:406-414. [PMID: 37487469 DOI: 10.1159/000533201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 07/10/2023] [Indexed: 07/26/2023]
Abstract
INTRODUCTION The Fetal Medicine Foundation (FMF) London developed a first trimester combined screening algorithm for preterm preeclampsia (pPE) that allows a significantly higher detection of pregnancies at risk compared to conventional screening by maternal risk factors only. The aim of this trial is to validate this screening model in the Swiss population in order to implement this screening into routine first trimester ultrasound and to prescribe low-dose aspirin 150 mg (LDA) in patients at risk for pPE. Therefore, a multicentre registry study collecting and screening pregnancy outcome data was initiated in 2020; these are the preliminary results. METHODS Between June 1, 2020, and May 31, 2021, we included all singleton pregnancies with pPE screening at the hospitals of Basel, Lucerne, and Bern. Multiple of medians of uterine artery pulsatility index (UtA-PI), mean arterial pressure (MAP), placental growth factor (PlGF), and pregnancy-associated plasma protein A (PAPP-A) as well as risks were analysed as calculated by each centre's software and recalculated on the FMF online calculator for comparative reasons. Statistical analyses were performed by GraphPad Version 9.1. RESULTS During the study period, 1,027 patients with singleton pregnancies were included. 174 (16.9%) had a risk >1:100 at first trimester combined screening. Combining the background risk, MAP, UtA-PI, and PlGF only, the cut-off to obtain a screen positive rate (SPR) of 11% is ≥1:75. Outcomes were available for 968/1,027 (94.3%) of all patients; 951 resulted in live birth. Fifteen (1.58%) developed classical preeclampsia (PE), 23 (2.42%) developed PE according to the International Society for the Study of Hypertension in Pregnancy (ISSHP) definition. CONCLUSION First trimester combined screening for PE and prevention with LDA results in a low prevalence of PE. The screening algorithm performs according to expectations; however, the cut-off of >1:100 results in a SPR above the accepted range and a cut-off of ≥1:75 should be considered for screening. More data are needed to evaluate, if these results are representative for the general Swiss population.
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Affiliation(s)
- Fabienne Trottmann
- Department of Obstetrics and Gynaecology, University Hospital of Bern, University of Bern, Inselspital, Bern, Switzerland,
| | - Pauline Challande
- Department of Obstetrics and Gynaecology, University Hospital of Bern, University of Bern, Inselspital, Bern, Switzerland
| | - Gwendolin Manegold-Brauer
- Department of Obstetrics and Gynaecology, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - Sara Ardabili
- Department of Obstetrics and Gynaecology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Irene Hösli
- Department of Obstetrics and Gynaecology, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - Heidrun Schönberger
- Department of Obstetrics and Gynaecology, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - Sofia Amylidi-Mohr
- Department of Obstetrics and Gynaecology, University Hospital of Bern, University of Bern, Inselspital, Bern, Switzerland
| | - Joachim Kohl
- Department of Obstetrics and Gynaecology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Markus Hodel
- Department of Obstetrics and Gynaecology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Daniel Surbek
- Department of Obstetrics and Gynaecology, University Hospital of Bern, University of Bern, Inselspital, Bern, Switzerland
| | - Luigi Raio
- Department of Obstetrics and Gynaecology, University Hospital of Bern, University of Bern, Inselspital, Bern, Switzerland
| | - Beatrice Mosimann
- Department of Obstetrics and Gynaecology, University Hospital of Basel, University of Basel, Basel, Switzerland
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Moungmaithong S, Kwan AH, Tse AW, Wong NK, Lam MS, Wang J, Poon LC, Sahota DS. Evaluation of first trimester maternal serum inhibin-A for preeclampsia screening. PLoS One 2023; 18:e0288289. [PMID: 37428792 DOI: 10.1371/journal.pone.0288289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 06/24/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND International professional organizations recommend aspirin prophylaxis to women screened high risk for preterm preeclampsia (PE) in the first trimester. The UK Fetal Medicine Foundation (FMF) screening test for preterm PE using mean arterial pressure (MAP), uterine artery pulsatility index (UTPI) and placental growth factor (PlGF) was demonstrated to have lower detection rate (DR) in Asian population studies. Additional biomarkers are therefore needed in Asian women to improve screening DRs as a significant proportion of women with preterm and term PE are currently not identified. OBJECTIVES To evaluate maternal serum inhibin-A at 11-13 weeks as an alternative to PlGF or as an additional biomarker within the FMF screening test for preterm PE. STUDY DESIGN This is a nested case-control study using pregnancies initially screened at 11-13 weeks for preterm PE using the FMF triple test in a non-intervention study conducted between December 2016 and June 2018. Inhibin-A levels were retrospectively measured in 1,792 singleton pregnancies, 112 (1.7%) with PE matched for time of initial screening with 1,680 unaffected pregnancies. Inhibin-A levels were transformed to multiple of the expected median (MoM). The distribution of log10 inhibin-A MoM in PE and unaffected pregnancies and the association between log10 inhibin-A MoM and gestational age (GA) at delivery in PE were assessed. The screening performance determined by area under receiver operating characteristic curves (AUC) and detection rates (DRs) at a 10% fixed false positive rate (FPR), for preterm and term PE was determined. All risks for preterm and term PE were based on the FMF competing risk model and Bayes theorem. Differences in AUC (ΔAUC) between different biomarker combinations were compared using the Delong test. McNemar's test was used to assess the off-diagonal change in screening performance at a fixed 10% FPR after adding inhibin-A or replacing PlGF in the preterm PE adjusted risk estimation model. RESULTS Inhibin-A levels in unaffected pregnancies were significantly dependent on GA, maternal age and weight and were lower in parous women with no previous history of PE. Mean log10 inhibin-A MoM in any-onset PE (p<0.001), preterm (p<0.001) and term PE (p = 0.015) pregnancies were all significantly higher than that of unaffected pregnancies. Log10 inhibin-A MoM was inversely but not significantly correlated (p = 0.165) with GA at delivery in PE pregnancies. Replacing PlGF with inhibin-A in the FMF triple test reduced AUC and DR from 0.859 and 64.86% to 0.837 and 54.05%, the ΔAUC was not statistically significant. AUC and DR when adding inhibin-A to the FMF triple test were 0.814, 54.05% and the -0.045 reduction in AUC was statistically significant (p = 0.001). At a fixed 10% FPR, replacing PlGF with inhibin-A identified 1 (2.7%) additional pregnancy but missed 5 (13.5%) pregnancies which subsequently developed preterm PE identified by the FMF triple test. Adding inhibin-A missed 4 (10.8%) pregnancies and did not identify any additional pregnancies with preterm PE. CONCLUSION Replacing PlGF by inhibin-A or adding inhibin-A as an additional biomarker in and to the FMF triple screening test for preterm PE does not improve screening performance and will fail to identify pregnancies that are currently identified by the FMF triple test.
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Affiliation(s)
- Sakita Moungmaithong
- Department of Obstetrics and Gynaecology, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Angel H Kwan
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ada W Tse
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Natalie K Wong
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Michelle S Lam
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jing Wang
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Liona C Poon
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
- Shenzhen Research Institute, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Daljit S Sahota
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
- Shenzhen Research Institute, The Chinese University of Hong Kong, Hong Kong SAR, China
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11
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Johnson JM, Walsh JD, Okun NB, Metcalfe A, Pastuck ML, Maxey CM, Soliman N, Mahallati H, Kuret VH, Dwinnell SJ, Chada R, O'Quinn CP, Schacher J, Somerset DA, Paterson K, Suchet IB, Silang KA, Paul H, Nerenberg KA, Johnson DW. The Implementation of Preeclampsia Screening and Prevention (IMPRESS) Study. Am J Obstet Gynecol MFM 2023; 5:100815. [PMID: 36400421 DOI: 10.1016/j.ajogmf.2022.100815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Preeclampsia affects between 2% and 5% of pregnancies and is one of the leading causes of perinatal morbidity and mortality worldwide. Despite strong evidence that the combination of systematic preeclampsia screening based on the Fetal Medicine Foundation preeclampsia risk calculation algorithm with treatment of high-risk patients with low-dose aspirin reduces the incidence of preterm preeclampsia more than currently used risk-factor-based screening, real-world implementation studies have not yet been done in Canada. OBJECTIVE This study aimed to assess the operational feasibility of implementing first-trimester screening and prevention of preterm preeclampsia (<37 weeks) alongside a publicly funded first-trimester combined screening program for aneuploidies. STUDY DESIGN This was a prospective implementation study. Consecutive pregnant patients referred for first-trimester combined screening (11-13+6 weeks) were offered screening for preeclampsia based on the Fetal Medicine Foundation algorithm concomitantly with their aneuploidy screen. Consenting participants were screened using maternal risk factors, mean arterial pressure, uterine artery Doppler pulsatility index, pregnancy-associated plasma protein-A, and placental growth factor. Risk for preterm preeclampsia (<37 weeks) was calculated using the Fetal Medicine Foundation algorithm, and individuals with a risk score ≥1 per 100 were recommended to use aspirin (162 mg once daily at bedtime, <16-36 weeks). Implementation metrics assessed included: acceptability, operational impact, proportion of aspirin initiation, quality and safety measures, and screen performance. RESULTS Between December 1, 2020 and April 23, 2021, 1124 patients consented to preeclampsia screening (98.3% uptake), and 92 (8.2%) screened positive. Appointments for patients receiving first-trimester combined screening aneuploidy and preeclampsia screening averaged 6 minutes longer than first-trimester combined screening alone, and adding uterine artery Doppler pulsatility index averaged 2 minutes. Of the 92 patients who screened as high-risk for preeclampsia, 72 (78.3%) were successfully contacted before 16 weeks' gestation. Of these, 62 (86.1%) initiated aspirin, and 10 (13.9%) did not. Performance audit identified a consistent negative bias with mean arterial pressure measurements (median multiple of the median <1 in 10%); other variables were satisfactory. There were 7 cases of preterm preeclampsia (0.69%): 5 and 2 in the high- and low-risk groups, respectively. Screening detected 5 of 7 (71.4 %) preterm preeclampsia cases, with improved performance after adjustment for aspirin treatment effect. CONCLUSION This study confirms the operational feasibility of implementing an evidence-based preeclampsia screening and prevention program in a publicly funded Canadian setting. This will facilitate implementation into clinical service and the scaling up of this program at a regional and provincial level.
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Affiliation(s)
- J M Johnson
- Departments of Obstetrics and Gynecology (Drs J Johnson and Walsh, Ms Pastuck, Dr Metcalfe, Mr Maxey, and Drs Soliman, Kuret, Dwinnell, Chada, O'Quinn, Schacher, and Somerset).
| | - Jennifer D Walsh
- Departments of Obstetrics and Gynecology (Drs J Johnson and Walsh, Ms Pastuck, Dr Metcalfe, Mr Maxey, and Drs Soliman, Kuret, Dwinnell, Chada, O'Quinn, Schacher, and Somerset)
| | - Nanette B Okun
- Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada (Dr Okun)
| | - Amy Metcalfe
- Departments of Obstetrics and Gynecology (Drs J Johnson and Walsh, Ms Pastuck, Dr Metcalfe, Mr Maxey, and Drs Soliman, Kuret, Dwinnell, Chada, O'Quinn, Schacher, and Somerset)
| | - Melanie L Pastuck
- Departments of Obstetrics and Gynecology (Drs J Johnson and Walsh, Ms Pastuck, Dr Metcalfe, Mr Maxey, and Drs Soliman, Kuret, Dwinnell, Chada, O'Quinn, Schacher, and Somerset)
| | - Connor M Maxey
- Departments of Obstetrics and Gynecology (Drs J Johnson and Walsh, Ms Pastuck, Dr Metcalfe, Mr Maxey, and Drs Soliman, Kuret, Dwinnell, Chada, O'Quinn, Schacher, and Somerset)
| | - Nancy Soliman
- Departments of Obstetrics and Gynecology (Drs J Johnson and Walsh, Ms Pastuck, Dr Metcalfe, Mr Maxey, and Drs Soliman, Kuret, Dwinnell, Chada, O'Quinn, Schacher, and Somerset)
| | - Houman Mahallati
- Radiology (Drs Mahallati, Paterson, and Suchet), Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Verena H Kuret
- Departments of Obstetrics and Gynecology (Drs J Johnson and Walsh, Ms Pastuck, Dr Metcalfe, Mr Maxey, and Drs Soliman, Kuret, Dwinnell, Chada, O'Quinn, Schacher, and Somerset)
| | - Shannon J Dwinnell
- Departments of Obstetrics and Gynecology (Drs J Johnson and Walsh, Ms Pastuck, Dr Metcalfe, Mr Maxey, and Drs Soliman, Kuret, Dwinnell, Chada, O'Quinn, Schacher, and Somerset)
| | - Rati Chada
- Departments of Obstetrics and Gynecology (Drs J Johnson and Walsh, Ms Pastuck, Dr Metcalfe, Mr Maxey, and Drs Soliman, Kuret, Dwinnell, Chada, O'Quinn, Schacher, and Somerset)
| | - Candace P O'Quinn
- Departments of Obstetrics and Gynecology (Drs J Johnson and Walsh, Ms Pastuck, Dr Metcalfe, Mr Maxey, and Drs Soliman, Kuret, Dwinnell, Chada, O'Quinn, Schacher, and Somerset)
| | - Jaime Schacher
- Departments of Obstetrics and Gynecology (Drs J Johnson and Walsh, Ms Pastuck, Dr Metcalfe, Mr Maxey, and Drs Soliman, Kuret, Dwinnell, Chada, O'Quinn, Schacher, and Somerset)
| | - David A Somerset
- Departments of Obstetrics and Gynecology (Drs J Johnson and Walsh, Ms Pastuck, Dr Metcalfe, Mr Maxey, and Drs Soliman, Kuret, Dwinnell, Chada, O'Quinn, Schacher, and Somerset)
| | - Kimiko Paterson
- Radiology (Drs Mahallati, Paterson, and Suchet), Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Ian B Suchet
- Radiology (Drs Mahallati, Paterson, and Suchet), Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Katherine A Silang
- Department of Psychology, University of Calgary, Calgary, Canada (Ms Silang)
| | - Heather Paul
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Canada (Dr Paul)
| | - Kara A Nerenberg
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada (Dr Nerenberg)
| | - David W Johnson
- Departments of Pediatrics, Emergency Medicine, and Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Canada (Dr D Johnson)
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Uterine artery Doppler indices throughout gestation in women with and without previous Cesarean deliveries: a prospective longitudinal case-control study. Sci Rep 2022; 12:20913. [PMID: 36463315 PMCID: PMC9719472 DOI: 10.1038/s41598-022-25232-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 11/28/2022] [Indexed: 12/07/2022] Open
Abstract
To determine whether a history of previous Cesarean delivery (CD) impacts uterine artery (UtA) Doppler indices throughout pregnancy. Women with and without CD (NCD) were prospectively enrolled for sequential assessments of the UtA mean/median pulsatility index (UtA-PI), resistance index (UtA-RI), and systolic/diastolic ratio (UtA-S/D) at 11-13 + 6, 14-19 + 6, 30-34 + 6, and 35-37 + 6 weeks' gestation. Data from 269/269, 246/257, 237/254, and 219/242 CD/NCD participants from each gestational period were available for analysis. Multiples of the median (MoMs) of UtA Doppler indices showed biphasic temporal (Δ) pattern; with an initial dropping until the second trimester, then a subsequent elevation until late in pregnancy (p < 0.05). The measurements and Δs of the UtA indices between CD and NCD were not different (p > 0.05). Mixed-effects modelling ruled out effects from nulliparity (n = 0 and 167 for CD and NCD, respectively) (p > 0.05). History of CD neither influenced the measurements nor the temporal changes of the UtA Doppler indices throughout pregnancy. The biphasic Δs of UtA Doppler indices added to the longitudinal data pool, and may aid in future development of a more personalized prediction using sequential/contingent methodologies, which may reduce the false results from the current cross-sectional screening.
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Danielli M, Thomas RC, Gillies CL, Hu J, Khunti K, Tan BK. Blood biomarkers to predict the onset of pre-eclampsia: A systematic review and meta-analysis. Heliyon 2022; 8:e11226. [PMID: 36387521 PMCID: PMC9649987 DOI: 10.1016/j.heliyon.2022.e11226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/29/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022] Open
Abstract
Pre-eclampsia is one of the most common pregnancy complications, and a major cause of fetal and maternal morbidity and mortality globally. Diagnosis currently takes place in the third trimester based on clinical symptoms. This systematic review and meta-analysis sought to determine the blood biomarkers that are associated with pre-eclampsia, and in particular, the biomarkers that could predict pre-eclampsia in early pregnancy. We searched the electronic databases (Medline, Embase, Cochrane Library) from inception up to March 2022. Prospective studies with 1000 or more participants that measured blood biomarkers to predict or diagnose pre-eclampsia have been included in this systematic review. Biomarkers' measurements were considered from the first up to the third trimester, but not during labor. Data concerning pre-eclampsia, biomarker measurements and study characteristics were extracted. Meta-analysis was performed when possible. We found a total of 43 studies (assessing 62 different biomarkers in 18,170 pregnancies, have been included in this systematic review, and a total of 6 studies (assessing 2 biomarkers have been included in the meta-analysis). Statistical analysis was performed for PlGF and sFlt-1. Mean difference in PlGF levels between pre-eclampsia and healthy pregnancies, appear to increase as the pregnancy progresses. Results of sFlt-1 meta-analysis were inconclusive. No significant publication bias was identified. This is the most comprehensive and up to date systematic review and meta-analysis on this important topic on blood biomarkers for the early prediction of pre-eclampsia. Further This research highlights the urgent needed for further discovery research to identify blood biomarkers that could predict the development of pre-eclampsia.
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Affiliation(s)
- Marianna Danielli
- Cardiovascular Sciences, University of Leicester, Leicester, LE1 7RH, United Kingdom
| | - Roisin C. Thomas
- Cardiovascular Sciences, University of Leicester, Leicester, LE1 7RH, United Kingdom
| | - Clare L. Gillies
- Diabetes Research Centre, Leicester General Hospital, Leicester, LE5 4PW, United Kingdom
| | - Jiamiao Hu
- Engineering Research Centre of Fujian-Taiwan Special Marine Food Processing and Nutrition, Ministry of Education, Fuzhou, Fujian, China
| | - Kamlesh Khunti
- Diabetes Research Centre, Leicester General Hospital, Leicester, LE5 4PW, United Kingdom
- NIHR Applied Research Collaboration – East Midlands (ARC-EM), Leicester General Hospital, Leicester, LE5 4PW, United Kingdom
| | - Bee Kang Tan
- Cardiovascular Sciences, University of Leicester, Leicester, LE1 7RH, United Kingdom
- Diabetes Research Centre, Leicester General Hospital, Leicester, LE5 4PW, United Kingdom
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Non-Coding RNAs and Prediction of Preeclampsia in the First Trimester of Pregnancy. Cells 2022; 11:cells11152428. [PMID: 35954272 PMCID: PMC9368389 DOI: 10.3390/cells11152428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/02/2022] [Accepted: 08/03/2022] [Indexed: 12/13/2022] Open
Abstract
Preeclampsia (PE) is a major cause of maternal and perinatal morbidity and mortality. The only fundamental treatment for PE is the termination of pregnancy. Therefore, not only severe maternal complications but also perinatal complications due to immaturity of the infant associated with early delivery are serious issues. The treatment and prevention of preterm onset preeclampsia (POPE) are challenging. In 2017, the ASPRE trial showed that a low oral dose of aspirin administered to POPE high-risk women in early pregnancy reduced POPE by 62%. A prediction algorithm at 11–13 weeks of gestation identifies POPE with 75% sensitivity when the false positive rate is set at 10%. New biomarkers to increase the accuracy of the prediction model for POPE high-risk women in early pregnancy are needed. In this review, we focused on non-coding RNAs (ncRNAs) as potential biomarkers for the prediction of POPE. Highly expressed ncRNAs in the placenta in early pregnancy may play crucial roles in placentation. Furthermore, placenta-specific ncRNAs have been detected in maternal blood. In this review, we summarized ncRNAs that were highly expressed in the primary human placenta in early pregnancy. We also presented highly expressed ncRNAs in the placenta that were associated with or predictive of the development of PE in an expression analysis of maternal blood during the first trimester of pregnancy. These previous studies showed that the chromosome 19 microRNA (miRNA) -derived miRNAs (e.g., miR-517-5p, miR-518b, and miR-520h), the hypoxia-inducible miRNA (miR-210), and long non-coding RNA H19, were not only highly expressed in the early placenta but were also significantly up-regulated in the blood at early gestation in pregnant women who later developed PE. These maternal circulating ncRNAs in early pregnancy are expected to be possible biomarkers for POPE.
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Wah YMI, Sahota DS, Chaemsaithong P, Wong L, Kwan AHW, Ting YH, Law KM, Leung TY, Poon LC. Impact of replacing or adding pregnancy-associated plasma protein-A at 11-13 weeks on screening for preterm pre-eclampsia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 60:200-206. [PMID: 35468236 DOI: 10.1002/uog.24918] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/31/2022] [Accepted: 04/12/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To assess whether pregnancy-associated plasma protein-A (PAPP-A) alters or provides equivalent screening performance as placental growth factor (PlGF) when screening for preterm pre-eclampsia (PE) at 11-13 weeks of gestation. METHODS This was a secondary analysis of a non-intervention screening study of 6546 singleton pregnancies that were screened prospectively for preterm PE in the first trimester between December 2016 and June 2018. Patient-specific risks for preterm PE were estimated by maternal history, mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI), PlGF and PAPP-A. A competing-risks model with biomarkers expressed as multiples of the median was used. All women and clinicians were blinded to the risk for preterm PE. The performance of screening for preterm PE using PlGF vs PAPP-A vs both PAPP-A and PlGF was assessed by comparing areas under the receiver-operating-characteristics (AUC) curves. McNemar's test was used to compare detection rate at a fixed false-positive rate (FPR) of 10%. RESULTS PlGF and PAPP-A were measured in 6546 women, of whom 37 developed preterm PE. The AUC and detection rate at 10% FPR using PlGF in combination with maternal history, MAP and UtA-PI were 0.854 and 59.46%, respectively. The respective values were 0.813 and 51.35% when replacing PlGF with PAPP-A and 0.855 and 59.46% when using both PAPP-A and PlGF. Statistically non-significant differences were noted in AUC when replacing PlGF with PAPP-A (ΔAUC, 0.04; P = 0.095) and when using both PAPP-A and PlGF (ΔAUC, 0.002; P = 0.423). However, on an individual case basis, screening using PlGF in conjunction with maternal history, MAP and UtA-PI identified three (8.1%) additional pregnancies that developed preterm PE and that were not identified when replacing PlGF with PAPP-A. Screening using PAPP-A in addition to maternal history and other biomarkers did not identify any additional pregnancies. CONCLUSION On an individual case basis, adoption of a screening strategy that uses PAPP-A instead of PlGF results in reduced detection of preterm PE, consistent with previous literature. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- Y M I Wah
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China
| | - D S Sahota
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China
| | - P Chaemsaithong
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China
| | - L Wong
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China
| | - A H W Kwan
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China
| | - Y H Ting
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China
| | - K M Law
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China
| | - T Y Leung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China
| | - L C Poon
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China
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Zou XY, Yang N, Cai W, Niu XL, Wei MT, Zhang X, Li YM. The relationship between high-normal blood pressure in the first half of pregnancy and the risk of hypertensive disease of pregnancy. J Clin Hypertens (Greenwich) 2022; 24:1079-1085. [PMID: 35857707 PMCID: PMC9380145 DOI: 10.1111/jch.14551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/13/2022] [Accepted: 07/01/2022] [Indexed: 11/29/2022]
Abstract
Early warning of hypertensive disorder in pregnancy (HDP) can improve maternal and infant outcomes. However, few studies had evaluated the warning value of high–normal blood pressure (BP) before the onset of HDP. This was a prospective cohort study to investigate the relationship between high‐normal BP in the first half of pregnancy and the risk of HDP. According to the maximum BP measured before 20+6 weeks of gestation, the cohort was divided into three groups: optimal BP (SBP < 120 mmHg and DBP < 80 mmHg), normal BP (120 mmHg ≤ SBP < 130 mmHg or 80 mmHg ≤ DBP < 85 mmHg), and high–normal BP (130 mmHg ≤ SBP < 140 mmHg or 85 mmHg ≤ DBP < 90 mmHg). The relationship between different BP levels in the first half of pregnancy and HDP risk was assessed by general linear models. Ten thousand one hundred and ninety‐three normotensive pregnant women with complete information were finally included for data analysis. Among them, 532 pregnant women were diagnosed with HDP, with a total HDP incidence of 5.2%. The incidences in the optimal, normal, and high–normal BP groups were 2.4%, 6.0%, and 21.8%, respectively. Compared to women with optimal BP in the first half of pregnancy, women with high‐normal BP had a 445% increased risk of HDP (aRR: 5.45, 95% CI: 4.24–7.00), and even women with normal BP had a 107% increased risk of HDP (aRR: 2.07, 95% CI: 1.68–2.56). This study demonstrated that among low‐risk healthy women, women with high–normal BP in the first half of pregnancy had a significantly higher risk of HDP.
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Affiliation(s)
- Xiao-Yi Zou
- Department of Cardiology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, R. P. China.,Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Characteristic Medical Center of PAP, Tianjin, R. P. China
| | - Ning Yang
- Department of Hypertension, Tianjin Economic-Technological Development Area (TEDA) International Cardiovascular Hospital, Tianjin, R.P. China
| | - Wei Cai
- Department of Prevention and Therapy of Cardiovascular Diseases in Alpine Environment of Plateau, Characteristic Medical Center of PAP, Tianjin, R.P. China
| | - Xiu-Long Niu
- Department of Prevention and Therapy of Skin Disease in the Security Environment, Characteristic Medical Center of PAP, Tianjin, R.P. China
| | - Mao-Ti Wei
- Center of Clinical Epidemiology, Tianjin Economic-Technological Development Area (TEDA) International Cardiovascular Hospital, Tianjin, R.P. China
| | - Xin Zhang
- Department of Cardiology, Characteristic Medical Center of PAP, Tianjin, R.P. China
| | - Yu-Ming Li
- Department of Cardiology, Tianjin Economic-Technological Development Area (TEDA) International Cardiovascular Hospital, Tianjin, R.P. China
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17
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Shen L, Sahota DS, Chaemsaithong P, Tse WT, CHUNG MY, Ip JKH, Leung TY, Poon LC. First trimester screening for gestational diabetes mellitus with maternal factors and biomarkers. Fetal Diagn Ther 2022; 49:256-264. [DOI: 10.1159/000525384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 05/20/2022] [Indexed: 11/19/2022]
Abstract
Introduction: This study aimed to identify risk factors among maternal characteristics, obstetric history and first trimester preeclampsia-specific biomarkers that were associated with subsequent development of gestational diabetes mellitus (GDM) and evaluate the performance of the prediction models.
Methods: Secondary analysis of a prospective cohort study. The performance of the prediction models was assessed by area under receiver operating characteristic curve (AUROC).
Results: A total of 837 (8.9%) cases of GDM and 8535 (91.1%) unaffected cases were included. The AUROC of the prediction model combining maternal characteristics and obstetric history (0.735) was better than that of the model utilizing maternal characteristics (AUROC 0.708) and preeclampsia-specific biomarkers (AUROC 0.566). Amongst the preeclampsia-specific biomarkers, the mean arterial pressure (MAP) contributed to the increasing risk of GDM, however, its addition did not improve the AUROC of the model combining maternal characteristics and obstetric history (0.738).
Conclusion: The first trimester prediction model for GDM with maternal characteristics and obstetric history achieves moderate predictability. The inclusion of MAP in the model combining maternal characteristics and obstetric history does not improve the screening performance for GDM. Future studies are needed to explore the effect of blood pressure control from early pregnancy on preventing GDM.
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18
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Choorakuttil RM, Rajalingam B, Satarkar SR, Sharma LK, Gupta A, Baghel A, Jain N, Palanisamy D, Shenoy R, Senthilvel K, Dhankar S, Aneja K, Dwivedi S, Nagar S, Soni SK, Chhajer G, Pradeep S, Onkar PM, Skandhan AK, Rajput E, Sharma R, Shentar S, Saboo S, Antony A, Nair MB, Patekar TY, Ahuja B, Patel H, Kunnumal M, Sodani RK, Rao MK, Bhatele P, Kavthale S, Patkar D, Singh R, Chelladurai A, Nirmalan PK. Reducing Perinatal Mortality in India: Two-Years Results of the IRIA Fetal Radiology Samrakshan Program. Indian J Radiol Imaging 2022; 32:30-37. [PMID: 35722649 PMCID: PMC9200467 DOI: 10.1055/s-0041-1741087] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Abstract
Aim The aim of the study is to determine improvements in perinatal mortality at the end of the first 2 years from the initiation of the Samrakshan program of the Indian Radiological and Imaging Association.
Methods Samrakshan is a screening program of pregnant women that uses trimester-specific risk assessment protocols including maternal demographics, mean arterial pressure, and fetal Doppler studies to classify women as high risk or low risk for preterm preeclampsia (PE) and fetal growth restriction (FGR). Low dose aspirin 150 mg daily once at bedtime was started for pregnant women identified as high risk in the 11–136/7 weeks screening. The third-trimester screening focused on the staging of FGR and protocol-based management for childbirth and risk assessment for PE. Outcomes of childbirth including gestational age at delivery, development of PE, and perinatal mortality outcomes were collected.
Results Radiologists from 38 districts of 16 states of India participated in the Samrakshan program that screened 2,816 first trimester, 3,267 second trimester, and 3,272 third trimester pregnant women, respectively. At 2 years, preterm PE was identified in 2.76%, preterm births in 19.28%, abnormal Doppler study in 25.76% of third trimester pregnancies, and 75.32% of stage 1 FGR delivered at term. The neonatal mortality rate was 9.86/1,000 live births, perinatal mortality rate was 18.97/1,000 childbirths, and maternal mortality was 58/100,000 live births compared with 29.5, 36, and 113, respectively in 2016.
Conclusion Fetal Doppler integrated antenatal ultrasound studies in Samrakshan led to a significant reduction in preterm PE rates, preterm birth rates, and a significant improvement in mean birth weights. Perinatal, neonatal, and maternal mortality rates are significantly better than the targets for 2030 set by the Sustainable Development Goals-3.
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Affiliation(s)
- Rijo M. Choorakuttil
- Department of Radiodiagnosis, AMMA Center for Diagnosis and Preventive Medicine Pvt Ltd, Kochi, Kerala, India
| | - Bavaharan Rajalingam
- Department of Radiodiagnosis, Fetocare Magnum Imaging and Diagnostics, Trichy, Tamil Nadu, India
| | - Shilpa R. Satarkar
- Department of Radiodiagnosis, Antarang Sonography and Colour Doppler Center, Satarkar Hospital, Aurangabad, Maharashtra, India
| | - Lalit K. Sharma
- Department of Radiodiagnosis, Raj Sonography & X-Ray Clinic, Baiju Choraha, Nayapura, Guna, Madhya Pradesh, India
| | - Anjali Gupta
- Department of Radiodiagnosis, Anjali Ultrasound and Colour Doppler Centre, 2nd floor, Shanti Madhuban Plaza, Delhi Gate, Agra, Uttar Pradesh, India
| | - Akanksha Baghel
- Department of Radiodiagnosis, Baghel Sonography Center, Harda, Madhya Pradesh, India
| | - Neelam Jain
- Department of Radiodiagnosis, Jain Ultrasound Centre, Sonari, Jamshedpur, Jharkhand, India
| | - Devarajan Palanisamy
- Department of Radiodiagnosis, Nethra Scans and Genetic Clinic, Tiruppur, Tamil Nadu, India
| | - Ramesh Shenoy
- Department of Radiodiagnosis, Consultant Radiologist, Lisie Hospital, Ernakulam, Kerala, India
| | | | - Sandhya Dhankar
- Department of Radiodiagnosis, Faith Diagnostic Center, Chandigarh, India
| | - Kavita Aneja
- Department of Radiodiagnosis, Images Ultrasound Center, Naveda Healthcare Centre, New Delhi, India
| | - Somya Dwivedi
- Department of Radiodiagnosis, Qura Diagnostics & Research Center, Bhopal, Madhya Pradesh, India
| | - Shweta Nagar
- Department of Radiodiagnosis, Dr. Shweta Nagar's Ultrasound Clinic & Imaging Centre, Indore, Madhya Pradesh, India
| | - Sonali Kimmatkar Soni
- Department of Radiodiagnosis, Navya Diagnostic Center, Near Nissan Motors, Walmiki statue, Gawal mandi, Putlighar, Amritsar, Punjab, India
| | - Gulab Chhajer
- Department of Radiodiagnosis, Kushal Imaging & Diagnostic Center, Sumerpur, Pali, Rajasthan, India
| | | | | | | | - Eesha Rajput
- Department of Radiology, INHS Dhanvantari, Minnie Bay, Port Blair, Andaman & Nicobar Islands, India
| | - Renu Sharma
- Department of Radiodiagnosis, Dr Renu's Diagnostic Center, Sikar, Rajasthan, India
| | - Srinivas Shentar
- Department of Radiodiagnosis, Delta Diagnostic Services, Basavanagudi, Bengaluru, Karnataka, India
| | - Suresh Saboo
- Department of Radiology, JIJU, IIMS Medical College, Jalna, Maharashtra, India
| | - Amel Antony
- Department of Radiology, Lisie Hospital, Kochi, Ernakulam, Kerala, India
| | | | - Tejashree Y. Patekar
- Department of Radiology, Innovision Sonography and Imaging Center, Gangapur, Nashik, India
| | - Bhupendra Ahuja
- Department of Radiodiagnosis, Dr. Ahuja Ultrasonography and Colour Doppler Center, Delhi Gate, Agra, (Dr. Sarkar Market), Uttar Pradesh, India
| | - Hemant Patel
- Department of Radiodiagnosis, Gujarat Imaging Center, Navrangpura, Ahmedabad, Gujarat, India
| | - Mohanan Kunnumal
- Vice Chancellor, Kerala University of Health Sciences, Thrissur, Kerala, India
| | - Rajendra K. Sodani
- Department of Radiodiagnosis, Sampurna Sodani Diagnostic Clinic, Indore, Madhya Pradesh, India
| | - M.V. Kameswar Rao
- Department of Radiodiagnosis, MKCG Medical College, Berhampur, Odisha, India
| | - Pushparaj Bhatele
- Department of Radiodiagnosis, MRI Centre, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Sandeep Kavthale
- Department of Radiodiagnosis, Indian Radiological and Imaging Association (IRIA), India & Vision Diagnostic Center, Maharashtra, India
| | - Deepak Patkar
- Department of Radiodiagnosis, Nanavati Super Speciality Hospital, Mumbai, Maharashtra, India
| | - Rajeev Singh
- Department of Radiodiagnosis, Radiodiagnosis, Jaipur, Rajasthan, India
| | - Amarnath Chelladurai
- Department of Radiodiagnosis, Stanley Medical College, Chennai, Tamil Nadu, India
| | - Praveen K. Nirmalan
- Department of Research, AMMA Education and Research Foundation, AMMA Healthcare Research Gurukul, Kochi, Kerala, India
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Hurrell A, Webster L, Chappell LC, Shennan AH. The assessment of blood pressure in pregnant women: pitfalls and novel approaches. Am J Obstet Gynecol 2022; 226:S804-S818. [PMID: 33514455 DOI: 10.1016/j.ajog.2020.10.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/08/2020] [Accepted: 10/19/2020] [Indexed: 01/11/2023]
Abstract
Accurate assessment of blood pressure is fundamental to the provision of safe obstetrical care. It is simple, cost effective, and life-saving. Treatments for preeclampsia, including antihypertensive drugs, magnesium sulfate, and delivery, are available in many settings. However, the instigation of appropriate treatment relies on prompt and accurate recognition of hypertension. There are a number of different techniques for blood pressure assessment, including the auscultatory method, automated oscillometric devices, home blood pressure monitoring, ambulatory monitoring, and invasive monitoring. The auscultatory method with a mercury sphygmomanometer and the use of Korotkoff sounds was previously recommended as the gold standard technique. Mercury sphygmomanometers have been withdrawn owing to safety concerns and replaced with aneroid devices, but these are particularly prone to calibration errors and regular calibration is imperative to ensure accuracy. Automated oscillometric devices are straightforward to use, but the physiological changes in healthy pregnancy and pathologic changes in preeclampsia may affect the accuracy of a device and monitors must be validated. Validation protocols classify pregnant women as a "special population," and protocols must include 15 women in each category of normotensive pregnancy, hypertensive pregnancy, and preeclampsia. In addition to a scarcity of devices validated for pregnancy and preeclampsia, other pitfalls that cause inaccuracy include the lack of training and poor technique. Blood pressure assessment can be affected by maternal position, inappropriate cuff size, conversation, caffeine, smoking, and irregular heart rate. For home blood pressure monitoring, appropriate instruction should be given on how to use the device. The classification of hypertension and hypertensive disorders of pregnancy has recently been revised. These are classified as preeclampsia, transient gestational hypertension, gestational hypertension, white-coat hypertension, masked hypertension, chronic hypertension, and chronic hypertension with superimposed preeclampsia. Blood pressure varies across gestation and by ethnicity, but gestation-specific thresholds have not been adopted. Hypertension is defined as a sustained systolic blood pressure of ≥140 mm Hg or a sustained diastolic blood pressure of ≥90 mm Hg. In some guidelines, the threshold of diagnosis depends on the setting in which blood pressure measurement is taken, with a threshold of 140/90 mm Hg in a healthcare setting, 135/85 mm Hg at home, or a 24-hour average blood pressure on ambulatory monitoring of >126/76 mm Hg. Some differences exist among organizations with respect to the criteria for the diagnosis of preeclampsia and the correct threshold for intervention and target blood pressure once treatment has been instigated. Home blood pressure monitoring is currently a focus for research. Novel technologies, including early warning devices (such as the CRADLE Vital Signs Alert device) and telemedicine, may provide strategies that prompt earlier recognition of abnormal blood pressure and therefore improve management. The purpose of this review is to provide an update on methods to assess blood pressure in pregnancy and appropriate technique to optimize accuracy. The importance of accurate blood pressure assessment is emphasized with a discussion of preeclampsia prediction and treatment of severe hypertension. Classification of hypertensive disorders and thresholds for treatment will be discussed, including novel developments in the field.
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Affiliation(s)
- Alice Hurrell
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom
| | - Louise Webster
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom
| | - Lucy C Chappell
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom
| | - Andrew H Shennan
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom.
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Amylidi-Mohr S, Kubias J, Neumann S, Surbek D, Risch L, Raio L, Mosimann B. Reducing the Risk of Preterm Preeclampsia: Comparison of Two First Trimester Screening and Treatment Strategies in a Single Centre in Switzerland. Geburtshilfe Frauenheilkd 2021; 81:1354-1361. [PMID: 34899048 PMCID: PMC8654509 DOI: 10.1055/a-1332-1437] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/07/2020] [Indexed: 01/16/2023] Open
Abstract
Introduction
First trimester screening for preeclampsia (PE) is based on the combined risks model. Recent trials demonstrate that variations in multiple of the medians (MoMs) of the screening markers influence the performance of the algorithm in different populations. The aim of this study is to compare the performance of the algorithm in two cohorts with different prevention strategies.
Material and Methods
All first trimester screening tests performed between January 2014 and April 2020 were included. Up to June 2017 pregnancies with a risk > 1 : 200 for early-onset PE (eoPE) were considered at risk and received 100 mg of aspirin (strategy A). From July 2017 onwards, pregnancies with a risk > 1 : 100 for preterm PE (pPE) received 150 mg of aspirin (strategy B). We compared the screen positive rates (SPR) and incidence of PE between the two screening approaches. Statistical analysis were performed with Graphpad 8.0.
Results
3552 pregnancies were included; 1577 pregnancies were screened according to strategy A, 1975 pregnancies according to strategy B. The screen positive rate (SPR) for strategy A and B was 8.9 and 16.9% respectively (p < 0.0001) while the incidence of PE was 1.41 and 1.84% respectively (p = ns).
Conclusion
With a SPR of less than 10% we achieved a remarkably low rate of PE in our population, no further reduction in PE could be achieved by an increase in the SPR and LDA-prescription during the second screening period. The cut-off to define a pregnancy at risk for PE should be tailored to keep the SPR below 10% to avoid unnecessary treatment with aspirin.
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Affiliation(s)
- Sofia Amylidi-Mohr
- Department of Obstetrics and Gynaecology, University Hospital of Bern, University of Bern, Inselspital, Bern, Switzerland
| | - Jakub Kubias
- Department of Obstetrics and Gynaecology, University Hospital of Bern, University of Bern, Inselspital, Bern, Switzerland
| | - Stefanie Neumann
- Department of Obstetrics and Gynaecology, University Hospital of Bern, University of Bern, Inselspital, Bern, Switzerland
| | - Daniel Surbek
- Department of Obstetrics and Gynaecology, University Hospital of Bern, University of Bern, Inselspital, Bern, Switzerland
| | - Lorenz Risch
- Division of Clinical Chemistry, Labormedizinisches Zentrum Dr. Risch, Bern, Switzerland
| | - Luigi Raio
- Department of Obstetrics and Gynaecology, University Hospital of Bern, University of Bern, Inselspital, Bern, Switzerland
| | - Beatrice Mosimann
- Department of Obstetrics and Gynaecology, University Hospital of Bern, University of Bern, Inselspital, Bern, Switzerland
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Prasad S, Sahota DS, Vanamail P, Sharma A, Arora S, Kaul A. Performance of Fetal Medicine Foundation algorithm for first trimester preeclampsia screening in an indigenous south Asian population. BMC Pregnancy Childbirth 2021; 21:805. [PMID: 34863125 PMCID: PMC8642869 DOI: 10.1186/s12884-021-04283-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/03/2021] [Indexed: 11/30/2022] Open
Abstract
Background To evaluate the performance of the Fetal Medicine Foundation (FMF) preterm preeclampsia (PE) screening algorithm in an indigenous South Asian population. Methods This was a prospective observational cohort study conducted in a tertiary maternal fetal unit in Delhi, India over 2 years. The study population comprised of 1863 women carrying a singleton pregnancy and of South Asian ethnicity who were screened for preterm pre-eclampsia (PE) between 11 and 14 weeks of gestation using Mean Arterial Pressure (MAP), transvaginal Mean Uterine Artery Pulsatility Index (UtAPI) and biochemical markers - Pregnancy Associated Plasma Protein-A (PAPP-A) and Placental Growth Factor.. Absolutemeasurements of noted biomarkers were converted to multiples of the expected gestational median (MoMS) which were then used to estimate risk for preterm PE < 37 weeks using Astraia software. Women with preterm PE risk of ≥1:100 was classified as as high risk. Detection rates (DR) at 10% false positive rate were calculated after adjusting for prophylactic aspirin use (either 75 or 150 mg). Results The incidence of PE and preterm PE were 3.17% (59/1863) and 1.34% (25/1863) respectively. PAPP-A and PlGF MoM distribution medians were 0.86 and 0.87 MoM and significantly deviated from 1 MoM. 431 (23.1%) women had a risk of ≥1:100, 75 (17.8%) of who received aspirin. Unadjusted DR using ≥1:100 threshold was 76%.Estimated DRs for a fixed 10% FPR ranged from 52.5 to 80% depending on biomarker combination after recentering MoMs and adjusting for aspirin use. Conclusion The FMF algorithm whilst performing satisfactorily could still be further improved to ensure that biophysical and biochemical markers are correctly adjusted for indigenous South Asian women.
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Affiliation(s)
| | - Daljit Singh Sahota
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong Prince of Wales Hospital, Shatin, Hong Kong, SAR.
| | - P Vanamail
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Anita Kaul
- Head of the Department and Clinical Coordinator, Apollo Centre for Fetal Medicine, Indraprastha Apollo Hospital, New Delhi, India.
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Chaiyasit N, Sahota DS, Ma R, Choolani M, Wataganara T, Sim WS, Chaemsaithong P, Wah YMI, Hui SYA, Poon LC. Prospective Evaluation of International Prediction of Pregnancy Complications Collaborative Network Models for Prediction of Preeclampsia: Role of Serum sFlt-1 at 11-13 Weeks' Gestation. Hypertension 2021; 79:314-322. [PMID: 34689595 DOI: 10.1161/hypertensionaha.121.18021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The study aimed to investigate whether serum sFlt-1 (soluble fms-like tyrosine kinase-1) at 11-13 weeks' gestation in pregnancies that subsequently developed preeclampsia was different from those without preeclampsia and compare screening performance of the International Prediction of Pregnancy Complications (IPPIC) reported models, which include various combinations of maternal factors, systolic blood pressure, diastolic blood pressure, PlGF (placental growth factor) and sFlt-1 and the competing risk (CR) models, which include various combinations of maternal factors, mean arterial pressure (MAP) and PlGF for predicting any-onset, early-onset, and late-onset preeclampsia. This was a prospective multicenter study in 7877 singleton pregnancies. The differences of the predictive performance between the IPPIC and CR models were compared. There were 141 women (1.79%) who developed preeclampsia, including 13 cases (0.17%) of early-onset preeclampsia and 128 cases (1.62%) of late-onset preeclampsia. In pregnancies that developed preeclampsia compared to unaffected pregnancies, median serum sFlt-1 levels and its MoMs were not significantly different (p>0.05). There was no significant association between gestational age at delivery and log10 sFlt-1 and log10 sFlt-1 MoM (p>0.05). The areas under the curve of CR models were significantly higher than the IPPIC models for the prediction of any-onset and late-onset preeclampsia but not for early-onset preeclampsia. In conclusion, there are no significant differences in the maternal serum sFlt-1 levels at 11-131 weeks' gestation between women who subsequently develop preeclampsia and those who do not. Moreover, the CR models for the prediction of any-onset and late-onset preeclampsia perform better than the IPPIC reported model.
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Affiliation(s)
- Noppadol Chaiyasit
- From King Chulalongkorn Memorial Hospital, Bangkok, Thailand (Noppadol Chaiyasit)
| | - Daljit S Sahota
- The Chinese University of Hong Kong, Hong Kong SAR (D.S.S., Y.M.I.W., S.Y.A.H., L.C.P.)
| | - Runmei Ma
- First Affiliated Hospital of Kunming Medical University, Kunming, China (R.M.)
| | | | - Tuangsit Wataganara
- Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand (T.W.)
| | - Wen Shan Sim
- KK Women's and Children's Hospital, Singapore (W.S.S.)
| | - Piya Chaemsaithong
- Department of Obstetrics and Gynecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (P.C.)
| | - Yi Man Isabella Wah
- The Chinese University of Hong Kong, Hong Kong SAR (D.S.S., Y.M.I.W., S.Y.A.H., L.C.P.)
| | - Shuk Yi Annie Hui
- The Chinese University of Hong Kong, Hong Kong SAR (D.S.S., Y.M.I.W., S.Y.A.H., L.C.P.)
| | - Liona C Poon
- The Chinese University of Hong Kong, Hong Kong SAR (D.S.S., Y.M.I.W., S.Y.A.H., L.C.P.)
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Zhu J, Zhang J, Syaza Razali N, Chern B, Tan KH. Mean arterial pressure for predicting preeclampsia in Asian women: a longitudinal cohort study. BMJ Open 2021; 11:e046161. [PMID: 34389562 PMCID: PMC8365796 DOI: 10.1136/bmjopen-2020-046161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE 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. DESIGN A prospective cohort study. SETTING KK Women's and Children's Hospital, Singapore. PARTICIPANTS 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. PRIMARY AND SECONDARY OUTCOMES Preeclampsia was the main pregnancy outcome. RESULTS 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. CONCLUSION MAP is a good predictor for preeclampsia, especially term preeclampsia, in Asian women.
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Affiliation(s)
- Jing Zhu
- 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
| | - Jun Zhang
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Division of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore
| | - Nurul Syaza Razali
- Division of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore
| | - Bernard Chern
- Division of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore
| | - Kok Hian Tan
- Division of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore
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Risk Factors for Preeclampsia: Results from a Cohort of Over 5000 Pregnancies in Spain. MATERNAL-FETAL MEDICINE 2021. [DOI: 10.1097/fm9.0000000000000098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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26
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A meta-analysis of the vascular endothelial growth factor polymorphisms associated with the risk of pre-eclampsia. Biosci Rep 2021; 40:222591. [PMID: 32255175 PMCID: PMC7240197 DOI: 10.1042/bsr20190209] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 02/08/2020] [Accepted: 03/19/2020] [Indexed: 12/31/2022] Open
Abstract
Backgroud: Pre-eclampsia (PE) is a common pregnancy-induced hypertension disease. Some case–control studies reported the association between vascular endothelial growth factor (VEGF) gene polymorphisms (rs3025039, rs2010963) and PE risk. However, these associations were inconsistent in several studies. Therefore, we conducted this meta-analysis to assess the role of VEGF gene polymorphisms in PE more precisely. Methods: Eligible studies were searched in PubMed, Embase, Web of Science and Chinese (Chinese National Knowledge Infrastructure (CNKI) and WanFang) databases. Statistical analyses were performed by Stata 12.0 software. Odds ratio (OR) and 95% confidence interval (CI) were used to assess the strength of the association. In addition, subgroup analyses, sensitive analyses and publication bias analyses were performed to further assess this meta-analysis. Results: In total, 21 studies were included in the meta-analysis covering 2018 cases and 2632 controls. There were significant associations between VEGF polymorphisms (rs3025039, rs2010963) and PE risk in the overall populations. In the subgroup analyses, we found that rs3025039 polymorphism was associated with the increased risk of PE among Chinese. As for rs2010963 polymorphism, a significant association was observed in subgroup of Caucasian. Conclusion: The present study suggested that the two VEGF gene polymorphisms (rs3025039, rs2010963) are associated with increased risk of PE in different ethnic groups, which means that the targets may be useful genetic markers for early prediction of PE.
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Lin TY, Huang HY, Chan KS, Chen YT, Chu FC, Shaw SW. Current update of first trimester preeclampsia screening in Asia. J Obstet Gynaecol Res 2020; 47:26-33. [PMID: 33063401 DOI: 10.1111/jog.14524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 08/31/2020] [Accepted: 09/28/2020] [Indexed: 11/30/2022]
Abstract
In consideration of high prevalence of preeclampsia, enormous studies attempted to look for strategies in early gestation. Hence, a powerful screening should be built up in first trimester. Then, Aspirin could be administrated for proper prevention. The objective of this article is reviewing the screening for preeclampsia in first trimester recently. To identify the high-risk group precisely, an effective model should be recommended to Asian population. Articles related to first trimester screening of PE in Asia from databases of PubMed, ScienceDirect and Scopus were searched for this narrative review. The criteria included randomized clinical trials, observational prospective and retrospective cohort studies, case-control studies, systematic review and meta-analysis and professional review articles. Screening models combining maternal factors, biophysical factors, ultrasound studies and biochemical factors achieved high predictive performance of preeclampsia. In Asia, the detection rate of the Fetal Medicine Foundation is superior to those of the American College of Obstetricians and Gynecologists and the National Institute for Health and Care Excellence. Consequently, this effective model from the Fetal Medicine Foundation should be continuously used for screening in first trimester for the Asian.
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Affiliation(s)
- Tzu-Yi Lin
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hui-Yu Huang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Obstetrics and Gynecology, Taipei Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Kok-Seong Chan
- Department of Obstetrics and Gynecology, Taipei Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Yen-Tin Chen
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Obstetrics and Gynecology, Taipei Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Fu-Chieh Chu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Obstetrics and Gynecology, Taipei Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Steven W Shaw
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Obstetrics and Gynecology, Taipei Chang Gung Memorial Hospital, Taipei, Taiwan.,Prenatal Cell and Gene Therapy Group, Institute for Women's Health University College London, London, UK
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