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Aerden M, De Borre M, Thienpont B. Cell-free DNA methylation-based preeclampsia prediction: A journey to improve maternal health. Prenat Diagn 2024; 44:418-421. [PMID: 38047711 DOI: 10.1002/pd.6478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/20/2023] [Accepted: 11/20/2023] [Indexed: 12/05/2023]
Abstract
Presymptomatic prediction of preeclampsia (PE) is crucial to enable early prophylactic treatment. Current screening tools are either complex or lack predictive value. We recently demonstrated that cell-free DNA methylation can be leveraged to predict early-onset PE in 57% at a 10% false positive rate. Importantly, this minimally invasive screening test can be implemented as an add-on to current widespread noninvasive prenatal aneuploidy screening. Here, we highlight the pitfalls and promising prospects of this research.
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Affiliation(s)
- Mio Aerden
- Laboratory for Functional Epigenetics, Department of Human Genetics, KU Leuven, Leuven, Belgium
- Center for Human Genetics, University Hospitals Leuven, University of Leuven, Leuven, Belgium
| | - Marie De Borre
- Laboratory for Functional Epigenetics, Department of Human Genetics, KU Leuven, Leuven, Belgium
- Center for Human Genetics, University Hospitals Leuven, University of Leuven, Leuven, Belgium
| | - Bernard Thienpont
- Laboratory for Functional Epigenetics, Department of Human Genetics, KU Leuven, Leuven, Belgium
- KU Leuven Center for Single Cell Omics, Leuven, Belgium
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Sedaghati F, Gleason RL. A mathematical model of vascular and hemodynamics changes in early and late forms of preeclampsia. Physiol Rep 2023; 11:e15661. [PMID: 37186372 PMCID: PMC10132946 DOI: 10.14814/phy2.15661] [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: 01/22/2023] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 05/17/2023] Open
Abstract
Preeclampsia-eclampsia syndrome is a leading cause of maternal mortality. The precise etiology of preeclampsia is still not well-defined and different forms exist, including early and late forms or preeclampsia, which may arise via distinctly different mechanisms. Low-dose aspirin administered at the end of the first trimester in women identified as high risk has been shown to reduce the incidence of early, but not late, preeclampsia; however, current risk factors show only fair predictive capability. There is a pressing need to develop accurate descriptions for the different forms of preeclampsia. This paper presents 1D fluid, solid, growth, and remodeling models for pregnancies complicated with early and late forms of preeclampsia. Simulations affirm a broad set of literature results that early forms of preeclampsia are characterized by elevated uterine artery pulsatility index (UA-PI) and total peripheral resistance (TPR) and lower cardiac output (CO), with modestly increased mean arterial blood pressure (MAP) in the first half of pregnancy, with elevation of TPR and MAP beginning at 20 weeks. Conversely, late forms of preeclampsia are characterized by only slightly elevated UA-PI and normal pre-term TPR, and slightly elevated MAP and CO throughout pregnancy, with increased TPR and MAP beginning after 34 weeks. Results suggest that preexisting arterial stiffness may be elevated in women that develop both early forms and late forms of preeclampsia; however, data that verify these results are lacking in the literature. Pulse wave velocity increases in early- and late-preeclampsia, coincident with increases in blood pressure; however, these increases are mainly due to the strain-stiffening response of larger arteries, rather than arterial remodeling-derived changes in material properties. These simulations affirm that early forms of preeclampsia may be associated with abnormal placentation, whereas late forms may be more closely associated with preexisting maternal cardiovascular factors; simulations also highlight several critical gaps in available data.
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Affiliation(s)
- Farbod Sedaghati
- The George W. Woodruff School of Mechanical EngineeringGeorgia Institute of TechnologyAtlantaGeorgiaUSA
| | - Rudolph L. Gleason
- The George W. Woodruff School of Mechanical EngineeringGeorgia Institute of TechnologyAtlantaGeorgiaUSA
- The Wallace H. Coulter Department of Biomedical EngineeringGeorgia Institute of TechnologyAtlantaGeorgiaUSA
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Uriel M, Romero Infante XC, Rincón Franco S, Ibáñez Pinilla EA, Rojas NA. Higher PAPP-A Values in Pregnant Women Complicated with Preeclampsia Than with Gestational Hypertension. Reprod Sci 2023:10.1007/s43032-023-01176-1. [PMID: 36917422 DOI: 10.1007/s43032-023-01176-1] [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: 02/21/2022] [Accepted: 01/20/2023] [Indexed: 03/15/2023]
Abstract
The purpose of this study is to compare the levels of maternal serum pregnancy-associated plasma protein-A at the first trimester in pregnancies complicated by impaired placental diseases, such as preeclampsia (PE), intrauterine fetal growth restriction (IUGR), and gestational hypertension (GH), with those in pregnancies without the development of any of these outcomes to expand the knowledge of how this protein behaves in the different impaired placental diseases. This current work is an observational study based on a prospective cohort. Pregnancy-associated plasma protein-A was measured in 422 patients who had completed maternal-perinatal outcomes. Comparisons of pregnancy characteristics and the biomarker between outcome groups (PE, IUGR, gestational hypertension, and not impaired placental outcomes) were analyzed. PAPP-A MoM in the IUGR (0.8 IQR: 0.6-0.9) and GH groups (0.5 IQR: 0.3-1.4) compared to the PE group (1.06 IQR: 0.66-1.52) was significantly lower (p < 0.005). Pregnant women who developed early-onset PE (1.11 IQR 1.08-1.18) presented significant differences with the IUGR group (0.83 IQR: 0.59-0.98; p = 0.002) and those who developed preterm-PE (1.19 IQR: 0.66-1.58; p = 0.045). The results demonstrate that the levels of PAPP-A at first trimester in the sample of women who developed PE, and specially term-PE, were higher than those in women who developed GH or IUGR. The GH group had the lowest PAPP-A values in this sample of pregnant women. Research in a population with a high prevalence of preeclampsia is still lacking and deserves more extended studies to define if these patients could have different rates of PAPP-A.
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Affiliation(s)
- Montserrat Uriel
- El Bosque Research Group of Maternal Fetal Medicine and Gynecology, Universidad El Bosque, Bogotá, Colombia.
- Ecodiagnóstico El Bosque S.A.S., Bogotá, Colombia.
- Los Cobos Medical Center, Bogotá, Colombia.
| | - Ximena Carolina Romero Infante
- El Bosque Research Group of Maternal Fetal Medicine and Gynecology, Universidad El Bosque, Bogotá, Colombia
- Ecodiagnóstico El Bosque S.A.S., Bogotá, Colombia
- Los Cobos Medical Center, Bogotá, Colombia
| | - Sara Rincón Franco
- El Bosque Research Group of Maternal Fetal Medicine and Gynecology, Universidad El Bosque, Bogotá, Colombia
- Ecodiagnóstico El Bosque S.A.S., Bogotá, Colombia
| | | | - Nydia Alexandra Rojas
- El Bosque Research Group of Maternal Fetal Medicine and Gynecology, Universidad El Bosque, Bogotá, Colombia
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Vallejo GM, Uriel M, Porras-Ramírez A, Romero XC. Could Aspirin Treatment Modify the Assessment of the Uterine Arteries? REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:231-237. [PMID: 35139575 PMCID: PMC9948068 DOI: 10.1055/s-0042-1742411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To analyze whether acetylsalicylic (ASA) intake modifies the mean uterine arteries pulsatility index (UtA-PI) at the 2nd or 3rd trimester in a cohort of pregnant women with abnormal mean UtA-PI at between 11 and 14 weeks of gestation. METHODS This is a retrospective cohort study. Singleton pregnancies with abnormal mean UtA-PI at between 11 and 14 weeks of gestation were studied. The participants were divided into 3 groups: 1) If the participant did not take ASA during pregnancy; 2) If the participant took ASA before 14 weeks of gestation; and 3) If the participant took ASA after 14 weeks of gestation. The mean UtA-PI was evaluated at the 2nd and 3rd trimesters, and it was considered to improve when it decreased below the 95th percentile. The prevalence ratio (PR) and the number needed to treat (NNT) were calculated. RESULTS A total of 72 participants with a mean UtA-PI > 95th percentile at the 1st trimester of gestation were evaluated. Out of the 18 participants who took ASA, 8 participants started it before 14 weeks of gestation and 10 after. A total of 33.3% of these participants had improved the mean UtA-PI at the 2nd and 3rd trimesters of gestation, although it was not statistically significant (p = 0.154). The prevalence ratio was 0.95 (95% confidence interval [CI]: 0.31-1.89), but between the 1st and 2nd trimesters of gestation, the PR was 0.92 (95%CI: 0.21-0.99) and it was statistically significant. CONCLUSION The present work demonstrates a modification of the mean UtA-PI in participants who took ASA compared with those who did not. It is important to check if ASA can modify the normal limits of uterine arteries because this could have an impact on surveillance.
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Affiliation(s)
- Gabriela Marisol Vallejo
- Universidad El Bosque, El Bosque Research Group of Maternal Fetal, Medicine and Gynecology, Ecodiagnóstico El Bosque SAS, Los Cobos Medical Center, Bogotá, Colombia
| | - Montserrat Uriel
- Universidad El Bosque, El Bosque Research Group of Maternal Fetal, Medicine and Gynecology, Ecodiagnóstico El Bosque SAS, Los Cobos Medical Center, Bogotá, Colombia
| | - Alexandra Porras-Ramírez
- Research Group Community Medicine and Collective Health, El Bosque University, Los Cobos Medical Center, Bogotá, Colombia
| | - Ximena Carolina Romero
- Universidad El Bosque, El Bosque Research Group of Maternal Fetal, Medicine and Gynecology, Ecodiagnóstico El Bosque SAS, Los Cobos Medical Center, Bogotá, Colombia
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A mathematical model of maternal vascular growth and remodeling and changes in maternal hemodynamics in uncomplicated pregnancy. Biomech Model Mechanobiol 2022; 21:647-669. [PMID: 35112224 DOI: 10.1007/s10237-021-01555-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 12/26/2021] [Indexed: 11/02/2022]
Abstract
The maternal vasculature undergoes tremendous growth and remodeling (G&R) that enables a > 15-fold increase in blood flow through the uterine vasculature from conception to term. Hemodynamic metrics (e.g., uterine artery pulsatility index, UA-PI) are useful for the prognosis of pregnancy complications; however, improved characterization of the maternal hemodynamics is necessary to improve prognosis. The goal of this paper is to develop a mathematical framework to characterize maternal vascular G&R and hemodynamics in uncomplicated human pregnancies. A validated 1D model of the human vascular tree from the literature was adapted and inlet blood flow waveforms at the ascending aorta at 4 week increments from 0 to 40 weeks of gestation were prescribed. Peripheral resistances of each terminal vessel were adjusted to achieve target flow rates and mean arterial pressure at each gestational age. Vessel growth was governed by wall shear stress (and axial lengthening in uterine vessels), and changes in vessel distensibility were related to vessel growth. Uterine artery velocity waveforms generated from this model closely resembled ultrasound results from the literature. The literature UA-PI values changed significantly across gestation, increasing in the first month of gestation, then dramatically decreasing from 4 to 20 weeks. Our results captured well the time-course of vessel geometry, material properties, and UA-PI. This 1D fluid-G&R model captured the salient hemodynamic features across a broad range of clinical reports and across gestation for uncomplicated human pregnancy. While results capture available data well, this study highlights significant gaps in available data required to better understand vascular remodeling in pregnancy.
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Chaemsaithong P, Sahota DS, Poon LC. First trimester preeclampsia screening and prediction. Am J Obstet Gynecol 2022; 226:S1071-S1097.e2. [PMID: 32682859 DOI: 10.1016/j.ajog.2020.07.020] [Citation(s) in RCA: 127] [Impact Index Per Article: 63.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/30/2020] [Accepted: 07/14/2020] [Indexed: 12/16/2022]
Abstract
Preeclampsia is a major cause of maternal and perinatal morbidity and mortality. Early-onset disease requiring preterm delivery is associated with a higher risk of complications in both mothers and babies. Evidence suggests that the administration of low-dose aspirin initiated before 16 weeks' gestation significantly reduces the rate of preterm preeclampsia. Therefore, it is important to identify pregnant women at risk of developing preeclampsia during the first trimester of pregnancy, thus allowing timely therapeutic intervention. Several professional organizations such as the American College of Obstetricians and Gynecologists (ACOG) and National Institute for Health and Care Excellence (NICE) have proposed screening for preeclampsia based on maternal risk factors. The approach recommended by ACOG and NICE essentially treats each risk factor as a separate screening test with additive detection rate and screen-positive rate. Evidence has shown that preeclampsia screening based on the NICE and ACOG approach has suboptimal performance, as the NICE recommendation only achieves detection rates of 41% and 34%, with a 10% false-positive rate, for preterm and term preeclampsia, respectively. Screening based on the 2013 ACOG recommendation can only achieve detection rates of 5% and 2% for preterm and term preeclampsia, respectively, with a 0.2% false-positive rate. Various first trimester prediction models have been developed. Most of them have not undergone or failed external validation. However, it is worthy of note that the Fetal Medicine Foundation (FMF) first trimester prediction model (namely the triple test), which consists of a combination of maternal factors and measurements of mean arterial pressure, uterine artery pulsatility index, and serum placental growth factor, has undergone successful internal and external validation. The FMF triple test has detection rates of 90% and 75% for the prediction of early and preterm preeclampsia, respectively, with a 10% false-positive rate. Such performance of screening is superior to that of the traditional method by maternal risk factors alone. The use of the FMF prediction model, followed by the administration of low-dose aspirin, has been shown to reduce the rate of preterm preeclampsia by 62%. The number needed to screen to prevent 1 case of preterm preeclampsia by the FMF triple test is 250. The key to maintaining optimal screening performance is to establish standardized protocols for biomarker measurements and regular biomarker quality assessment, as inaccurate measurement can affect screening performance. Tools frequently used to assess quality control include the cumulative sum and target plot. Cumulative sum is a sensitive method to detect small shifts over time, and point of shift can be easily identified. Target plot is a tool to evaluate deviation from the expected multiple of median and the expected median of standard deviation. Target plot is easy to interpret and visualize. However, it is insensitive to detecting small deviations. Adherence to well-defined protocols for the measurements of mean arterial pressure, uterine artery pulsatility index, and placental growth factor is required. This article summarizes the existing literature on the different methods, recommendations by professional organizations, quality assessment of different components of risk assessment, and clinical implementation of the first trimester screening for preeclampsia.
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Guzmán YN, Uriel M, Ramírez AP, Romero XC. Uterine Artery Pulsatility Index as a Pre-eclampsia Predictor in the 3 Trimesters in Women with Singleton Pregnancies. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2021; 43:904-910. [PMID: 34933383 PMCID: PMC10183923 DOI: 10.1055/s-0041-1740273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To evaluate the mean uterine artery pulsatility index (UtAPI) in each trimester of pregnancy as a predictor of early or late pre-eclampsia (PE) in Colombian pregnant women. METHODS The UtAPI was measured in singleton pregnancies in each trimester. Uterine artery pulsatility index as predictor of PE was evaluated by odds ratio (OR), receiver operating characteristic (ROC) curves, and Kaplan-Meier diagram. RESULTS Analysis in the 1st and 3rd trimester showed that abnormal UtAPI was associated with early PE (OR: 5.99: 95% confidence interval [CI]: 1.64-21.13; and OR: 10.32; 95%CI: 2.75-42.49, respectively). Sensitivity and specificity were 71.4 and 79.6%, respectively, for developing PE (area under the curve [AUC]: 0.922). The Kaplan-Meier curve showed that a UtAPI of 0.76 (95%CI: 0.58-1.0) in the 1st trimester was associated with early PE, and a UtAPI of 0.73 (95%CI: 0.55-0.97) in the 3rd trimester was associated with late PE. CONCLUSION Uterine arteries proved to be a useful predictor tool in the 1st and 3rd trimesters for early PE and in the 3rd trimester for late PE in a pregnant population with high prevalence of PE.
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Affiliation(s)
- Yuly Natalia Guzmán
- Universidad El Bosque, El Bosque Research Group of Maternal Fetal Medicine and Gynecology, Bogotá, Colombia
| | - Montserrat Uriel
- Universidad El Bosque, El Bosque Research Group of Maternal Fetal Medicine and Gynecology, Ecodiagnóstico El Bosque SAS, Los Cobos Medical Center, Bogotá, Colombia
| | - Alexandra Porras Ramírez
- Universidad El Bosque, Research Group Community Medicine and Collective Health, Los Cobos Medical Center, Bogotá, Colombia
| | - Ximena Carolina Romero
- Universidad El Bosque, El Bosque Research Group of Maternal Fetal Medicine and Gynecology, Ecodiagnóstico El Bosque SAS, Los Cobos Medical Center, Bogotá, Colombia
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Simula N, Brown R, Butt K, Morency AM, Demers S, Grigoriu A, Nevo O. Committee Opinion No. 418: The Complete 11-14 Week Prenatal Sonographic Examination. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 43:1013-1021. [PMID: 34015553 DOI: 10.1016/j.jogc.2021.05.004] [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] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Sonography during the first trimester provides an opportunity to assess a pregnancy in its early stage. This document provides an opinion about the implementation and content of prenatal sonographic examinations at 11-14 weeks gestation in Canada. TARGET POPULATION Pregnant women at 11-14 weeks gestation. BENEFITS, HARMS, AND COSTS The 11-14 week prenatal sonographic examination can provide important information that may contribute to pregnancy management. It can be used to confirm viability, establish gestational age, determine the number of fetuses, assess the adnexa/ovaries, and, in a multiple pregnancy, assess chorionicity and amnionicity. Scanning also offers an opportunity to detect fetal abnormalities and perform aneuploidy screening by measuring the nuchal translucency thickness. It may be valuable in screening for preeclampsia and other obstetrical disorders (by combining uterine artery Doppler scanning with other bio-clinical markers) and for invasive placentation. There are no physical harms to mother or fetus from offering a routine 11-14 week prenatal sonographic examination, and there are no extra costs for patients. EVIDENCE Articles related to routine 11-14 week prenatal sonography were identified in a search of EMBASE and MEDLINE using the search terms first trimester ultrasound, nuchal translucency, and 11-14 week ultrasound. The search included all articles published on the topic until May 2019. Abstracts were reviewed by one author, and articles deemed relevant were then reviewed in full to determine whether to include them in the study. Articles that were not in English and articles that did not pertain to 11-14 week prenatal sonography were excluded. INTENDED AUDIENCE This document is intended for sonographers, midwives, family physicians, obstetricians, and maternal-fetal medicine specialists.
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Simula N, Brown R, Butt K, Morency AM, Demers S, Grigoriu A, Nevo O. Opinion de comité no 418 : Examen échographique prénatal complet entre 11 et 14 semaines d'aménorrhée. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 43:1022-1031. [PMID: 34015552 DOI: 10.1016/j.jogc.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Niyonzima FN, Dusabimana A, Mutijima JB. Pregnancy Induced Hypertension and Uric Acid Levels among Pregnant Women Attending Ruhengeri Referral Hospital, in Rwanda. East Afr Health Res J 2021; 5:44-49. [PMID: 34308244 PMCID: PMC8291203 DOI: 10.24248/eahrj.v5i1.650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 05/06/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Pregnancy Induced Hypertension (PIH) is a common burden during pregnancy usually associoted with adverse maternal and paternal outcomes. The uric acid serum level was identified as an important biochemical marker which can predict preeclampsia, a type of PIH. This study was conducted to evaluate the effects of serum uric acid levels in association with blood pressure among pregnant women attending Ruhengeri Referral Hospital. Methodology: A cross-sectional study was designed and 80 pregnant women in different gestation trimesters participated in the study. Data was collected from September to October 2018. Digital sphygmomanometer was used to test blood pressures for participants. Blood samples were collected in red top tubes and centrifuged to obtain serum for uric acid levels. Using Humastar 80, uric acid levels were measured for each participant. Data was analysed using Statistical Package for Social Sciences (SPSS) version 23.0. Bivariate correlation was used to analyse the relationship between uric acid levels and participants’ blood pressure. Results: The median age was 27 in interquartile 23-31 ranging from 19 to 39 years. 58.75% of participants were in their 1st trimester, followed by 21.25% in the 2nd trimester and 20% in the 3rd trimester. The prevalence of hypertension was 11.3% (7.5% for stage 1 and 3.8% for stage 2). Hyperuricemia was found in 15% of the participants. The mean of uric acid level was 7.12 ±1.86 mg/dl in the hypertensive group and 4.49 ±1.22 mg/dl in the non-hypertensive group. The study revealed a strong positive correlation between uric acid levels and systolic/diastolic blood pressure. Conclusion: High prevalence of hypertension among pregnant women was revealed. The association of hypertension and hyperuricemia was recorded with a strong correlation between blood pressures and serum uric acid levels. Examination of Uric acid levels among pregnant women should be routinely performed for early identification and management of hypertension.
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Affiliation(s)
- Francois Niyongabo Niyonzima
- Department of Biomedical Laboratory Sciences (BLS), Faculty of Applied Fundamental Sciences (AFS), INES - Institute of Applied Sciences, Rwanda
| | - Ally Dusabimana
- Department of Biomedical Laboratory Sciences (BLS), Faculty of Applied Fundamental Sciences (AFS), INES - Institute of Applied Sciences, Rwanda
| | - Jean Berchmas Mutijima
- Department of Biomedical Laboratory Sciences (BLS), Faculty of Applied Fundamental Sciences (AFS), INES - Institute of Applied Sciences, Rwanda
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Dobrowolski P, Kosinski P, Prejbisz A, Szczepkowska A, Klisiewicz A, Januszewicz M, Wielgos M, Januszewicz A, Hoffman P. Longitudinal changes in maternal left atrial volume index and uterine artery pulsatility indices in uncomplicated pregnancy. Am J Obstet Gynecol 2021; 224:221.e1-221.e15. [PMID: 32717256 DOI: 10.1016/j.ajog.2020.07.042] [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: 06/01/2020] [Revised: 07/10/2020] [Accepted: 07/22/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Data on the relationship between longitudinal changes in maternal volume-dependent echocardiographic parameters and placentation in uncomplicated pregnancy are limited. OBJECTIVE This study aimed to evaluate changes in volume-dependent echocardiographic parameters in uncomplicated pregnancy to test the hypothesis of the existence of an association between volume-dependent echocardiographic parameters and Doppler ultrasound parameters of fetal circulation and the uterine artery in uncomplicated pregnancy and to establish which of the volume-dependent echocardiographic parameters best depicts volume changes and correlates best with Doppler ultrasound of fetal circulation and the uterine artery in healthy pregnancy. STUDY DESIGN Data from 60 healthy pregnant women were analyzed. A complete echocardiographic study was performed at 11 to 13, 20 to 22, and 30 to 32 weeks' gestation: left ventricular end-diastolic volume, early diastolic peak flow velocity, late diastolic peak flow velocity, left atrial area, and left atrial volume index were assessed. Obstetrical assessment was performed including fetal growth and uterine artery pulsatility index. Fetal well-being was assessed by umbilical and middle cerebral artery blood flow. Serum pregnancy-associated plasma protein A and free β-human chorionic gonadotropin were assessed during the routine first-trimester scan (11-13 weeks' gestation). RESULTS Left ventricular end-diastolic volume and left atrial area increased significantly between 11 to 13 and 20 to 22 weeks' gestation but not between 20 to 22 and 30 to 32 weeks' gestation. Left atrial volume index measured at 30 to 32 weeks' gestation correlated with uterine artery pulsatility indices in 3 trimesters. Changes in the left atrial volume index between the third and first trimesters correlated significantly with the uterine artery pulsatility index measured at 20 to 22 weeks' gestation (r=-0.345; P=.020) and at 30 to 32 weeks' gestation (r=-0.452; P=.002). Changes in the left atrial volume index between the second and first trimesters significantly correlated with the uterine artery pulsatility index measured in the first trimester (r=-0.316; P=.025). CONCLUSION Our study showed that in an uncomplicated pregnancy, among volume-dependent echocardiographic parameters, left atrial volume index increased between both the first and second trimesters and the second and third trimesters and correlated with parameters of Doppler ultrasound of the fetal circulation and the uterine artery. Our results expand on the previous observation on the relationship between maternal cardiovascular adaptation and placentation in women with heart diseases to the population of healthy women with uncomplicated pregnancy.
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Romero Infante XC, Uriel M, Porras Ramírez A, Rincón Franco S. Comparison of preeclampsia and fetal growth restriction screenings at first trimester in a high-risk population. J Obstet Gynaecol Res 2020; 47:765-773. [PMID: 33325095 DOI: 10.1111/jog.14605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/29/2020] [Accepted: 12/02/2020] [Indexed: 11/29/2022]
Abstract
AIM To compare the sensitivity and specificity of screening for preeclampsia and FGR including maternal characteristics, mean arterial blood pressure and uterine artery pulsatility index and the combined screening, which adds biochemical markers, such as placental growth factor (PlGF) and pregnancy-associated plasma protein-A (PAPP-A), in a sample of high risk population for hypertensive disorders. METHODS This is a prospective study with 527 singleton pregnancies at 11-14 weeks of gestation. Maternal characteristics, biochemical and biophysical markers were studied to determine the development of preeclampsia and FGR by using receiver operating characteristic curves. RESULTS For preeclampsia, screening, including sociodemographic data plus biophysical markers, had a sensitivity and specificity of 70.3% (CI% 64.3-75.2) and 93.8% (CI% 90.9-96.8), respectively. Combined screening, which includes sociodemographic data, biophysical (mean blood pressure and uterine artery pulsatility index) and biochemical markers (PlGF and PAPP-A), increased sensitivity and specificity up to 85.5% (CI% 80.2-90.3) and 96.3% (CI% 91.4-98.9), respectively. For FGR, sociodemographic data plus biophysical markers had a sensitivity and specificity of 57.8% (CI% 50.1-63.4) and 80.1% (CI% 74.3-85.9), respectively. Combined screening increased sensitivity and specificity up to 67.2% (CI% 52.1-71.3) and 82.7% (CI% 75.2-90.1), respectively. CONCLUSION Combined screening for preeclampsia and FGR at 11 to 14 weeks of gestation, which includes maternal characteristics, mean blood pressure, uterine artery pulsatility index, PAPP-A and PlGF, has higher sensitivity and specificity than other screening options. Therefore, considering all these variables during screening is recommended for a superior opportunity of identifying pregnant women in risk for preeclampsia and FGR, especially in a high-risk population.
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Affiliation(s)
- Ximena Carolina Romero Infante
- Universidad El Bosque, Ecodiagnóstico El Bosque S. A. S, Los Cobos Medical Center, El Bosque Research Group of Maternal Fetal Medicine and Gynecology, Bogotá, Colombia
| | - Montserrat Uriel
- Universidad El Bosque, Ecodiagnóstico El Bosque S. A. S, Los Cobos Medical Center, El Bosque Research Group of Maternal Fetal Medicine and Gynecology, Bogotá, Colombia
| | - Alexandra Porras Ramírez
- Universidad El Bosque, Los Cobos Medical Center, Research Group Medicina Comunitaria y Salud Colectiva, Bogotá, Colombia
| | - Sara Rincón Franco
- Universidad El Bosque, Ecodiagnóstico El Bosque S. A. S, El Bosque Research Group of Maternal Fetal Medicine and Gynecology, Bogotá, Colombia
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Schaller S, Knippel AJ, Verde PE, Kozlowski P. Concordance-analysis and evaluation of different diagnostic algorithms used in first trimester screening for late-onset preeclampsia. Hypertens Pregnancy 2020; 39:172-185. [PMID: 32306791 DOI: 10.1080/10641955.2020.1750627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Objective: Concordance-analysis and evaluation of existing algorithms detecting late-onset preeclampsia during first trimester screeningMethods: Retrospective cohort study investigating risk algorithms of late-onset preeclampsia during first trimester screening in a German prenatal center. Three previously developed algorithms including anamnestic factors (Apriori) and biophysical markers (BioM) were investigated by using detection rates (DR) with fixed FPR 10% and fixed cutoff >1:100. Furthermore, we set up a concordance-analysis of test results in late-onset preeclampsia cases to examine the effect of influencing factors and to detect potential weaknesses of the algorithms. Therefore, we modeled the probability of discordances as a function of the influencing factors based on a logistic regression, that was fitted using a Bayesian approach.Results: 6,113 pregnancies were considered, whereof 700 have been excluded and 5,413 pregnancies were analyzed. 98 (1.8%) patients developed preeclampsia (79 late-onsets, 19 early-onsets). The Apriori-algorithm reaches a DR of 34.2%, by adding BioM (MAP and UtA-PI) the DR improves to 57.0% (FPR of 10%). In concordance-analysis of Apriori algorithm and Apriori+BioM algorithms, influencing factor BMI<25 increases the chance of discordances sigificantly. Additional, in the subgroup of late-onset preeclampsias with BMI<25 the DR is higher in Apriori+BioM algorithms than in Apriori algorithm alone. If both compared algorithms include BioM, influencing factor MAP decreases the chance of discordances significantly. All other tested influencing factors do not have a statistically significant effect on discordancesConclusion: Normal-weight patients benefit more from the integration of MAP and UtA-PI compared to overweight/obese patients.
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Affiliation(s)
- Sabrina Schaller
- Praenatal-Medizin und Genetik Ärztliche Partnerschaftsgesellschaft Kozlowski und Partner, Düsseldorf
| | | | - Pablo Emilio Verde
- Coordination Center for Clinical Trials, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Peter Kozlowski
- Praenatal-Medizin und Genetik Ärztliche Partnerschaftsgesellschaft Kozlowski und Partner, Düsseldorf
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Kongwattanakul K, Chaiyarach S, Hayakangchat S, Thepsuthammarat K. The Transverse versus the Sagittal Approach in First-Trimester Uterine Artery Doppler Measurement. Int J Womens Health 2019; 11:629-635. [PMID: 31849538 PMCID: PMC6910102 DOI: 10.2147/ijwh.s228619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 11/29/2019] [Indexed: 11/23/2022] Open
Abstract
Objective The uterine artery pulsatility index (UtA-PI) is an important marker for predicting and assessing the risk of various complications such as pre-eclampsia and fetal growth restriction. The measurement of UtA-PI in the first trimester is usually conducted via the sagittal approach. The aim of this study was to evaluate UtA Doppler measurement using the transverse approach in the first trimester. Methods This was a prospective observational study of 50 women with singleton pregnancy at between 11-13+6 weeks of gestation. Uterine artery (UtA) Doppler variables were measured using both the transverse and sagittal approach. The two approaches were compared in terms of time required to complete the measurements and early diastolic notch. The sample t-test and Wilcoxon rank sign test were used to analyze the outcomes when appropriate. Bland-Altman plots were used to determine the agreement between the two approaches. A P-value <0.05 was considered statistically significant. Intra-class correlation (ICC) was used to evaluate the reliability of measurements. Results There were a total of 50 pregnant women who participated in the study and completed the study protocol. The mean age of all subjects was 29.6 years, and 24 (48%) were nulliparous. We observed no difference in terms of mean UtA-PI between the two approaches (sagittal: 2.04, transverse: 2.03; mean difference 0.01, CI -0.01, 0.04; p>0.309), nor in the means of any other UtA variables. However, there were differences between the two approaches in terms of early diastolic notch (sagittal: 11, transverse: 13; p>0.999) and the mean time required to complete the measurements (transverse: 21.7 s, sagittal: 24.3 s; p=0.001). The intra-class correlation coefficients (ICCs) were 0.985, 0.963, and 0.988 for the right, left, and mean UtA-PIs respectively. Conclusion The transverse approach at a bladder depth of less than 5 cm performed better than the sagittal approach in the measurement of first-trimester uterine arteries. It may, thus, may be useful as a complementary approach in cases in which there is difficulty obtaining measurements using the sagittal approach.
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Affiliation(s)
- Kiattisak Kongwattanakul
- Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Sukanya Chaiyarach
- Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Suppasiri Hayakangchat
- Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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15
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Tarca AL, Romero R, Benshalom-Tirosh N, Than NG, Gudicha DW, Done B, Pacora P, Chaiworapongsa T, Panaitescu B, Tirosh D, Gomez-Lopez N, Draghici S, Hassan SS, Erez O. The prediction of early preeclampsia: Results from a longitudinal proteomics study. PLoS One 2019; 14:e0217273. [PMID: 31163045 PMCID: PMC6548389 DOI: 10.1371/journal.pone.0217273] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 05/08/2019] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES To identify maternal plasma protein markers for early preeclampsia (delivery <34 weeks of gestation) and to determine whether the prediction performance is affected by disease severity and presence of placental lesions consistent with maternal vascular malperfusion (MVM) among cases. STUDY DESIGN This longitudinal case-control study included 90 patients with a normal pregnancy and 33 patients with early preeclampsia. Two to six maternal plasma samples were collected throughout gestation from each woman. The abundance of 1,125 proteins was measured using high-affinity aptamer-based proteomic assays, and data were modeled using linear mixed-effects models. After data transformation into multiples of the mean values for gestational age, parsimonious linear discriminant analysis risk models were fit for each gestational-age interval (8-16, 16.1-22, 22.1-28, 28.1-32 weeks). Proteomic profiles of early preeclampsia cases were also compared to those of a combined set of controls and late preeclampsia cases (n = 76) reported previously. Prediction performance was estimated via bootstrap. RESULTS We found that 1) multi-protein models at 16.1-22 weeks of gestation predicted early preeclampsia with a sensitivity of 71% at a false-positive rate (FPR) of 10%. High abundance of matrix metalloproteinase-7 and glycoprotein IIbIIIa complex were the most reliable predictors at this gestational age; 2) at 22.1-28 weeks of gestation, lower abundance of placental growth factor (PlGF) and vascular endothelial growth factor A, isoform 121 (VEGF-121), as well as elevated sialic acid binding immunoglobulin-like lectin 6 (siglec-6) and activin-A, were the best predictors of the subsequent development of early preeclampsia (81% sensitivity, FPR = 10%); 3) at 28.1-32 weeks of gestation, the sensitivity of multi-protein models was 85% (FPR = 10%) with the best predictors being activated leukocyte cell adhesion molecule, siglec-6, and VEGF-121; 4) the increase in siglec-6, activin-A, and VEGF-121 at 22.1-28 weeks of gestation differentiated women who subsequently developed early preeclampsia from those who had a normal pregnancy or developed late preeclampsia (sensitivity 77%, FPR = 10%); 5) the sensitivity of risk models was higher for early preeclampsia with placental MVM lesions than for the entire early preeclampsia group (90% versus 71% at 16.1-22 weeks; 87% versus 81% at 22.1-28 weeks; and 90% versus 85% at 28.1-32 weeks, all FPR = 10%); and 6) the sensitivity of prediction models was higher for severe early preeclampsia than for the entire early preeclampsia group (84% versus 71% at 16.1-22 weeks). CONCLUSION We have presented herein a catalogue of proteome changes in maternal plasma proteome that precede the diagnosis of preeclampsia and can distinguish among early and late phenotypes. The sensitivity of maternal plasma protein models for early preeclampsia is higher in women with underlying vascular placental disease and in those with a severe phenotype.
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Affiliation(s)
- Adi L. Tarca
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, United States of America
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
- Department of Computer Science, Wayne State University College of Engineering, Detroit, Michigan, United States of America
| | - Roberto Romero
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, United States of America
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, United States of America
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, United States of America
| | - Neta Benshalom-Tirosh
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, United States of America
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Nandor Gabor Than
- Systems Biology of Reproduction Research Group, Institute of Enzymology, Research Centre for Natural Sciences, Hungarian Academy of Sciences, Budapest, Hungary
- First Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
- Maternity Clinic, Kutvolgyi Clinical Block, Semmelweis University, Budapest, Hungary
| | - Dereje W. Gudicha
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, United States of America
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Bogdan Done
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, United States of America
| | - Percy Pacora
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, United States of America
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Tinnakorn Chaiworapongsa
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, United States of America
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Bogdan Panaitescu
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, United States of America
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Dan Tirosh
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, United States of America
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Nardhy Gomez-Lopez
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, United States of America
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
- C.S. Mott Center for Human Growth and Development, Wayne State University, Detroit, Michigan, United States of America
- Department of Biochemistry, Microbiology, and Immunology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Sorin Draghici
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
- Department of Computer Science, Wayne State University College of Engineering, Detroit, Michigan, United States of America
| | - Sonia S. Hassan
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, United States of America
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
- Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Offer Erez
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, United States of America
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
- Maternity Department "D," Division of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
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De Kat AC, Hirst J, Woodward M, Kennedy S, Peters SA. Prediction models for preeclampsia: A systematic review. Pregnancy Hypertens 2019; 16:48-66. [PMID: 31056160 DOI: 10.1016/j.preghy.2019.03.005] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 03/11/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Preeclampsia is a disease specific to pregnancy that can cause severe maternal and foetal morbidity and mortality. Early identification of women at higher risk for preeclampsia could potentially aid early prevention and treatment. Although a plethora of preeclampsia prediction models have been developed in recent years, individualised prediction of preeclampsia is rarely used in clinical practice. OBJECTIVES The objective of this systematic review was to provide an overview of studies on preeclampsia prediction. STUDY DESIGN Relevant research papers were identified through a MEDLINE search up to 1 January 2017. Prognostic studies on the prediction of preeclampsia or preeclampsia-related disorders were included. Quality screening was performed with the Quality in Prognostic Studies (QUIPS) tool. RESULTS Sixty-eight prediction models from 70 studies with 425,125 participants were selected for further review. The number of participants varied and the gestational age at prediction varied widely across studies. The most frequently used predictors were medical history, body mass index, blood pressure, parity, uterine artery pulsatility index, and maternal age. The type of predictor (maternal characteristics, ultrasound markers and/or biomarkers) was not clearly associated with model discrimination. Few prediction studies were internally (4%) or externally (6%) validated. CONCLUSIONS To date, multiple and widely varying models for preeclampsia prediction have been developed, some yielding promising results. The high degree of between-study heterogeneity impedes selection of the best model, or an aggregated analysis of prognostic models. Before multivariable preeclampsia prediction can be clinically implemented universally, further validation and calibration of well-performing prediction models is needed.
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Affiliation(s)
- Annelien C De Kat
- The George Institute for Global Health, University of Oxford Le Gros Clark Building, South Parks Road, Oxford OX1 3QX, UK; Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.
| | - Jane Hirst
- The George Institute for Global Health, University of Oxford Le Gros Clark Building, South Parks Road, Oxford OX1 3QX, UK; Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Mark Woodward
- The George Institute for Global Health, University of Oxford Le Gros Clark Building, South Parks Road, Oxford OX1 3QX, UK; Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK; The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Stephen Kennedy
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Sanne A Peters
- The George Institute for Global Health, University of Oxford Le Gros Clark Building, South Parks Road, Oxford OX1 3QX, UK; Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK; The George Institute for Global Health, University of New South Wales, Sydney, Australia
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Sotiriadis A, Hernandez-Andrade E, da Silva Costa F, Ghi T, Glanc P, Khalil A, Martins WP, Odibo AO, Papageorghiou AT, Salomon LJ, Thilaganathan B. ISUOG Practice Guidelines: role of ultrasound in screening for and follow-up of pre-eclampsia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 53:7-22. [PMID: 30320479 DOI: 10.1002/uog.20105] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 07/15/2018] [Accepted: 07/22/2018] [Indexed: 06/08/2023]
Affiliation(s)
- A Sotiriadis
- Second Department of Obstetrics and Gynecology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - E Hernandez-Andrade
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Hutzel Women Hospital, Wayne State University, Detroit, MI, USA
| | - F da Silva Costa
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil; and Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - T Ghi
- Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - P Glanc
- Department of Radiology, University of Toronto, Toronto, Ontario, Canada
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK; and Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - W P Martins
- SEMEAR Fertilidade, Reproductive Medicine and Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - A O Odibo
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - A T Papageorghiou
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK; and Nuffield Department of Obstetrics and Gynecology, University of Oxford, Women's Center, John Radcliffe Hospital, Oxford, UK
| | - L J Salomon
- Department of Obstetrics and Fetal Medicine, Hopital Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, Paris Descartes University, Paris, France
| | - B Thilaganathan
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK; and Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
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Sundheimer LW, Chan JL, Buttle R, DiPentino R, Muramoto O, Castellano K, Wang ET, Williams J, Pisarska MD. Mode of conception does not affect fetal or placental growth parameters or ratios in early gestation or at delivery. J Assist Reprod Genet 2018; 35:1039-1046. [PMID: 29633147 DOI: 10.1007/s10815-018-1176-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 03/29/2018] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Ratio of fetal weight to placenta size varies by mode of conception (fertility treatments utilized) in animals. Our objective was to assess whether fertility treatments also affect these ratios in humans. METHODS In this retrospective study, we assessed two cohorts: (a) early gestation cohort, women with singleton pregnancies who underwent first trimester vaginal ultrasound and (b) delivered cohort, women who delivered a live-born, singleton infant with placenta disposition to pathology. Crown rump length (CRL) and estimated placental volume (EPV) were calculated from first trimester ultrasound images using a validated computation. Infant birth weight (BW), pregnancy data, placental weight (PW), and placental histopathology were collected. Fetal growth-to-placental weight ratios (CRL/EPV; BW/PW) and placentas were compared by mode of conception. Linear regression was used to adjust for confounding variables. RESULTS Two thousand one hundred seventy patients were included in the early gestation cohort and 1443 in the delivered cohort. Of the early gestation cohort (a), 85.4% were spontaneous conceptions, 5.9% Non-IVF Fertility (NIFT), and 8.7% IVF. In the delivered cohort (b), 92.4% were spontaneous, 2.1% NIFT, and 80 5.5% IVF. There were no significant differences between fetal growth-to-placental weight parameters, ratios, and neonatal birth measurements based on mode of conception. Placenta accreta was significantly higher in the patients receiving fertility treatments (1.2 versus 3.6%, p < 0.05). CONCLUSIONS Mode of conception does not appear to influence fetal growth-to-placental weight ratios throughout gestation. In addition, findings in animal models may not always translate into human studies of infertility treatment outcomes.
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Affiliation(s)
- Lauren W Sundheimer
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.,David Geffen School of Medicine, University of California, 8635 West Third Street, Suite 160W, Los Angeles, CA, 90048, USA
| | - Jessica L Chan
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Rae Buttle
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Rosemarie DiPentino
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Olivia Muramoto
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Kerlly Castellano
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Erica T Wang
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.,David Geffen School of Medicine, University of California, 8635 West Third Street, Suite 160W, Los Angeles, CA, 90048, USA
| | - John Williams
- David Geffen School of Medicine, University of California, 8635 West Third Street, Suite 160W, Los Angeles, CA, 90048, USA.,Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Margareta D Pisarska
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA. .,David Geffen School of Medicine, University of California, 8635 West Third Street, Suite 160W, Los Angeles, CA, 90048, USA.
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19
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Cheng Y, Leung TY, Law LW, Ting YH, Law KM, Sahota DS. First trimester screening for pre-eclampsia in Chinese pregnancies: case-control study. BJOG 2018; 125:442-449. [PMID: 29032578 DOI: 10.1111/1471-0528.14970] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the potential of screening for pre-eclampsia (PE) in a Chinese population. DESIGN Case-control study. SETTING Teaching hospital in Hong Kong. POPULATION A total of 3330 women having a viable singleton pregnancy attending first-trimester Down-syndrome screening. METHODS Mean arterial pressure (MAP), bilateral uterine artery pulsatility index (UtA-PI), and placental growth factor (PlGF) were measured. Screening markers were transformed to multiples of the gestational median (MoM) and adjusted for maternal and pregnancy characteristics. MoM distributions in PE and non-PE pregnancies were compared with published expected values. PE screening performance was assessed using area under receiver operating curves (AUROC). MAIN OUTCOME MEASURES PE detection rate. RESULTS A total of 30 (0.9%) women developed either early (<34 weeks) or late (≥34 weeks) onset PE. MAP was dependent on maternal BMI, UtA-PI on fetal crown rump length, uterine artery peak systolic velocity (UtA-PSV) on maternal age and gestation, and PlGF on gestation in non-PE pregnancies. MoM distributions determined using published Fetal Medicine Foundation models deviated significantly from one for both MAP (P < 0.0001) and PI (P < 0.0001), but not PlGF (P = 0.52) in non-PE pregnancies, whilst PlGF MoM distributions in those who developed early as opposed to late onset PE were significantly higher (P = <0.05). AUROC for any PE using multiple markers was 0.72 (95% CI: 0.64-0.81) with detection rates of 72 and 55% for early and late PE, respectively, for a 10% false positive rate. CONCLUSION Detection rates for PE in our Chinese population were lower than the expected 90-95% even after adjusting MoM for local women's characteristics. FUNDING General Research Fund (Project number 470513). TWEETABLE ABSTRACT Pre-eclampsia screening in the Chinese population had detection rates lower than previously published results.
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Affiliation(s)
- Yky Cheng
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - T Y Leung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - L W Law
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Y H Ting
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - K M Law
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - D S Sahota
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
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20
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Uterine artery Doppler: Changing Concepts in Prediction and Prevention of PE and FGR. JOURNAL OF FETAL MEDICINE 2017. [DOI: 10.1007/s40556-017-0150-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Abstract
Hypertensive disorders in pregnancy have been the cause of much clinical dilemma, affecting up to 10 % of all pregnancies. The precise blood pressure to achieve in a pregnant woman is usually a battle between minimizing end organ damage to the mother and providing adequate perfusion to the placenta and the fetus. This predicament is becoming more, not less, frequent as maternal ages increase in high resource nations. Biomarkers to predict preeclampsia, a subcategory of hypertension in pregnancy, have always been elusive. The discovery of angiogenic factors relevant to preeclampsia in the last decade, however, has propelled much needed research, both in the basic science and clinical arenas. In this review, we summarize the latest clinical studies and international guidelines on blood pressure goals in pregnancy, and discuss the most promising of biomarkers to predict or diagnose preeclampsia.
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Kumar M, Sharma K, Singh S, Singh R, Singh A, Bhattacharjee J. Use of first-trimester placenta growth factor concentration to predict hypertensive disorders of pregnancy in a low-risk Asian population. Int J Gynaecol Obstet 2017; 139:301-306. [DOI: 10.1002/ijgo.12301] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 06/23/2017] [Accepted: 08/15/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Manisha Kumar
- Department of Obstetrics and Gynecology; Lady Hardinge Medical College; New Delhi India
| | - Karuna Sharma
- Department of Biochemistry; Lady Hardinge Medical College; New Delhi India
| | - Shalini Singh
- Division of Reproductive Biology; Maternal and Child Health; Indian Council of Medical Research; New Delhi India
| | - Ritu Singh
- Department of Biochemistry; Lady Hardinge Medical College; New Delhi India
| | - Abha Singh
- Department of Obstetrics and Gynecology; Lady Hardinge Medical College; New Delhi India
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Diguisto C, Piver E, Gouge AL, Eboue F, Vaillant CL, Maréchaud M, Goua V, Giraudeau B, Perrotin F. First trimester uterine artery Doppler, sFlt-1 and PlGF to predict preeclampsia in a high-risk population. J Matern Fetal Neonatal Med 2017; 30:1514-1519. [DOI: 10.1080/14767058.2016.1183631] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Caroline Diguisto
- Department of Obstetrics, Gynecology and Fetal Medicine, University Hospital of Tours, 2 Boulevard Tonnellé, Tours Cedex 9, France
- Department of Medicine, University François Rabelais, Tours, France
| | - Eric Piver
- Department of Medicine, University François Rabelais, Tours, France
- Department of Biochemistry, University Hospital Tours, Tours, France
| | | | - Florence Eboue
- Department of Obstetrics, Gynecology and Fetal Medicine, University Hospital of Tours, 2 Boulevard Tonnellé, Tours Cedex 9, France
- Maternité Notre Dame de Bon Secours, Groupe Hospitalier Saint Joseph, Paris, France
| | | | - Martine Maréchaud
- Department of Obstetrics, University Hospital of Poitiers, Poitiers, France
| | - Valérie Goua
- Department of Obstetrics, University Hospital of Poitiers, Poitiers, France
| | - Bruno Giraudeau
- Department of Medicine, University François Rabelais, Tours, France
- INSERM CIC 1415, University Hospital Tours, Tours, France
| | - Franck Perrotin
- Department of Obstetrics, Gynecology and Fetal Medicine, University Hospital of Tours, 2 Boulevard Tonnellé, Tours Cedex 9, France
- Department of Medicine, University François Rabelais, Tours, France
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Maymon R, Trahtenherts A, Svirsky R, Melcer Y, Madar-Shapiro L, Klog E, Meiri H, Cuckle H. Developing a new algorithm for first and second trimester preeclampsia screening in twin pregnancies. Hypertens Pregnancy 2016; 36:108-115. [DOI: 10.1080/10641955.2016.1242605] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Ron Maymon
- Institute of Ultrasound, Department of Obstetrics and Gynecology, Assaf Harofeh Medical Centre, Affiliated with the Sackler School of Medicine, Tel-Aviv, Israel
- Tel-Aviv University, Tel-Aviv, Israel
| | | | - Ran Svirsky
- Institute of Ultrasound, Department of Obstetrics and Gynecology, Assaf Harofeh Medical Centre, Affiliated with the Sackler School of Medicine, Tel-Aviv, Israel
- Tel-Aviv University, Tel-Aviv, Israel
| | - Yaakov Melcer
- Institute of Ultrasound, Department of Obstetrics and Gynecology, Assaf Harofeh Medical Centre, Affiliated with the Sackler School of Medicine, Tel-Aviv, Israel
- Tel-Aviv University, Tel-Aviv, Israel
| | | | - Esther Klog
- Institute of Ultrasound, Department of Obstetrics and Gynecology, Assaf Harofeh Medical Centre, Affiliated with the Sackler School of Medicine, Tel-Aviv, Israel
- Tel-Aviv University, Tel-Aviv, Israel
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Di Martino DD, Stampalija T, Rosti E, Casati D, Signorelli V, Zullino S, Mastroianni C, Quadrifoglio M, Ferrazzi E. Bedside cardiovascular maternal interrogation in the first trimester to predict different phenotypes of hypertensive disorders in pregnancy. Pregnancy Hypertens 2016; 6:300-305. [DOI: 10.1016/j.preghy.2016.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 06/17/2016] [Indexed: 02/01/2023]
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Karampas GA, Eleftheriades MI, Panoulis KC, Rizou MD, Haliassos AD, Metallinou DK, Mastorakos GP, Rizos DA. Prediction of pre-eclampsia combining NGAL and other biochemical markers with Doppler in the first and/or second trimester of pregnancy. A pilot study. Eur J Obstet Gynecol Reprod Biol 2016; 205:153-7. [DOI: 10.1016/j.ejogrb.2016.08.034] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 08/10/2016] [Accepted: 08/13/2016] [Indexed: 01/16/2023]
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Gujral K, Nayar S. Prediction of Pre-eclampsia. JOURNAL OF FETAL MEDICINE 2016. [DOI: 10.1007/s40556-016-0087-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Rodriguez A, Tuuli MG, Odibo AO. First-, Second-, and Third-Trimester Screening for Preeclampsia and Intrauterine Growth Restriction. Clin Lab Med 2016; 36:331-51. [DOI: 10.1016/j.cll.2016.01.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Al-Rubaie ZTA, Askie LM, Ray JG, Hudson HM, Lord SJ. The performance of risk prediction models for pre-eclampsia using routinely collected maternal characteristics and comparison with models that include specialised tests and with clinical guideline decision rules: a systematic review. BJOG 2016; 123:1441-52. [DOI: 10.1111/1471-0528.14029] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2016] [Indexed: 12/17/2022]
Affiliation(s)
- ZTA Al-Rubaie
- School of Medicine; The University of Notre Dame Australia; Sydney NSW Australia
| | - LM Askie
- NHMRC Clinical Trials Centre; University of Sydney; Sydney NSW Australia
| | - JG Ray
- Departments of Medicine, Health Policy Management and Evaluation, and Obstetrics and Gynecology; St. Michael's Hospital; University of Toronto; Toronto ON Canada
| | - HM Hudson
- NHMRC Clinical Trials Centre; University of Sydney; Sydney NSW Australia
- Department of Statistics; Macquarie University; Sydney NSW Australia
| | - SJ Lord
- School of Medicine; The University of Notre Dame Australia; Sydney NSW Australia
- NHMRC Clinical Trials Centre; University of Sydney; Sydney NSW Australia
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Kane SC. First trimester screening for pre-eclampsia. Obstet Med 2016; 9:106-12. [PMID: 27630745 DOI: 10.1177/1753495x16649074] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 04/18/2016] [Indexed: 11/17/2022] Open
Abstract
The commercial availability of tests in the first trimester of pregnancy that predict the later development of pre-eclampsia has prompted considerable debate regarding their clinical utility and the degree to which they fulfil the longstanding principles of screening. Such tests have been shown to achieve detection rates for early pre-eclampsia (requiring delivery prior to 34 weeks) of over 90%, for a false positive rate of 10%. However, their capacity to predict later onset pre-eclampsia, which accounts for the bulk of the disease burden, is much more limited. The relatively few studies validating the performance of these tests in different populations have demonstrated significant variations in performance. Moreover, prospective research confirming that the administration of aspirin to those screened to be high risk reduces the incidence of pre-eclampsia is yet to be completed, and there may be harms in restricting aspirin therapy to this group, given its broader beneficial effect. In light of these limitations, further development of these tests is recommended prior to their introduction to clinical practice.
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Affiliation(s)
- Stefan C Kane
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia; Pregnancy Research Centre, Department of Maternal-Fetal Medicine, The Royal Women's Hospital, Parkville, Victoria, Australia
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Svirsky R, Levinsohn-Tavor O, Feldman N, Klog E, Cuckle H, Maymon R. First- and second-trimester maternal serum markers of pre-eclampsia in twin pregnancy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 47:560-564. [PMID: 25865365 DOI: 10.1002/uog.14873] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 03/30/2015] [Accepted: 04/05/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To evaluate the distribution of first- and second-trimester maternal serum markers in twin pregnancy with and without pre-eclampsia. METHODS One-hundred and forty-four twin and 109 unaffected singleton pregnancies were recruited from the same institution. First- and second-trimester maternal blood samples were stored and measured retrospectively for serum placental growth factor (PlGF), pregnancy-associated plasma protein-A (PAPP-A), free β-human chorionic gonadotropin (β-hCG) and α-fetoprotein (AFP). All had measurement of first-trimester serum markers, and 167 (66%) had second-trimester tests. Values were expressed in multiples of the gestation-specific median (MoMs) in singletons, adjusted for maternal weight, as appropriate. RESULTS Pre-eclampsia was diagnosed in 12 (9.0%) twin pregnancies of 133 continuing beyond 22 weeks. In unaffected twin pregnancies, all serum markers were statistically significantly increased (P < 0.0001), consistent with a doubling of concentration. Among twin pregnancies, those with pre-eclampsia had a significantly reduced median PlGF compared with surviving unaffected twin pregnancies (0.96 MoM vs 1.46 MoM; P < 0.0002, two-tailed), whilst median PAPP-A, which is known to be reduced in affected singleton pregnancies, was increased (3.91 MoM vs 2.43 MoM; P < 0.0005, two-tailed). The levels of free β-hCG (P < 0.02) and AFP (P < 0.05) were also significantly raised, but to a lesser extent than was the level of PAPP-A. Using a logistic regression algorithm based on first- and second-trimester PlGF and PAPP-A, together with previously published uterine artery Doppler and mean arterial pressure measurements in the same series, the predicted pre-eclampsia detection rate was 65% for a 10% false-positive rate. CONCLUSIONS In twin pregnancy, the predicted detection rate of pre-eclampsia using first- and second-trimester maternal serum and biophysical markers is good. In contrast to singleton pregnancy, PAPP-A levels are raised in the first trimester of twin pregnancies destined to develop pre-eclampsia and therefore a different prediction algorithm is needed. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- R Svirsky
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - O Levinsohn-Tavor
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - N Feldman
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - E Klog
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - H Cuckle
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - R Maymon
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Kleinrouweler CE, Cheong-See FM, Collins GS, Kwee A, Thangaratinam S, Khan KS, Mol BWJ, Pajkrt E, Moons KG, Schuit E. Prognostic models in obstetrics: available, but far from applicable. Am J Obstet Gynecol 2016; 214:79-90.e36. [PMID: 26070707 DOI: 10.1016/j.ajog.2015.06.013] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 05/20/2015] [Accepted: 06/01/2015] [Indexed: 12/18/2022]
Abstract
Health care provision is increasingly focused on the prediction of patients' individual risk for developing a particular health outcome in planning further tests and treatments. There has been a steady increase in the development and publication of prognostic models for various maternal and fetal outcomes in obstetrics. We undertook a systematic review to give an overview of the current status of available prognostic models in obstetrics in the context of their potential advantages and the process of developing and validating models. Important aspects to consider when assessing a prognostic model are discussed and recommendations on how to proceed on this within the obstetric domain are given. We searched MEDLINE (up to July 2012) for articles developing prognostic models in obstetrics. We identified 177 papers that reported the development of 263 prognostic models for 40 different outcomes. The most frequently predicted outcomes were preeclampsia (n = 69), preterm delivery (n = 63), mode of delivery (n = 22), gestational hypertension (n = 11), and small-for-gestational-age infants (n = 10). The performance of newer models was generally not better than that of older models predicting the same outcome. The most important measures of predictive accuracy (ie, a model's discrimination and calibration) were often (82.9%, 218/263) not both assessed. Very few developed models were validated in data other than the development data (8.7%, 23/263). Only two-thirds of the papers (62.4%, 164/263) presented the model such that validation in other populations was possible, and the clinical applicability was discussed in only 11.0% (29/263). The impact of developed models on clinical practice was unknown. We identified a large number of prognostic models in obstetrics, but there is relatively little evidence about their performance, impact, and usefulness in clinical practice so that at this point, clinical implementation cannot be recommended. New efforts should be directed toward evaluating the performance and impact of the existing models.
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Sørensen A, Sinding M, Peters DA, Petersen A, Frøkjær JB, Christiansen OB, Uldbjerg N. Placental oxygen transport estimated by the hyperoxic placental BOLD MRI response. Physiol Rep 2015; 3:3/10/e12582. [PMID: 26471757 PMCID: PMC4632952 DOI: 10.14814/phy2.12582] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Estimating placental oxygen transport capacity is highly desirable, as impaired placental function is associated with fetal growth restriction (FGR) and poor neonatal outcome. In clinical obstetrics, a noninvasive method to estimate the placental oxygen transport is not available, and the current methods focus on fetal well-being rather than on direct assessment of placental function. In this article, we aim to estimate the placental oxygen transport using the hyperoxic placental blood oxygen level-dependent (BOLD) magnetic resonance imaging (MRI) response. In 21 normal pregnancies and in four cases of severe early onset FGR, placental BOLD MRI was performed in a 1.5 Tesla MRI system (TR:8000 msec, TE:50 msec, Flip angle:90). Placental histological examination was performed in the FGR cases. In normal pregnancies, the average hyperoxic placental BOLD response was 12.6 ± 5.4% (mean ± SD). In the FGR cases, the hyperoxic BOLD response was abnormal only in cases with histological signs of maternal hypoperfusion of the placenta. The hyperoxic placental BOLD response is mainly derived from an increase in the saturation of maternal venous blood. In the normal placenta, the pO2 of the umbilical vein is closely related to the pO2 of the uterine vein. Therefore, the hyperoxic placental BOLD response may reflect the placental oxygen supply to the fetus. In early onset FGR, the placental oxygen transport is reduced mainly because of the maternal hypoperfusion, and in these cases the placental BOLD response might be altered. Thus, the placental BOLD MRI might provide direct noninvasive assessment of placental oxygen transport.
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Affiliation(s)
- Anne Sørensen
- Obstetrics and Gýnecology, Aalborg University Hospital, Aalborg, Denmark
| | - Marianne Sinding
- Obstetrics and Gýnecology, Aalborg University Hospital, Aalborg, Denmark
| | - David A Peters
- Clinical Engineering, Aarhus University Hospital, Aarhus, Denmark
| | | | - Jens B Frøkjær
- Radiology, Aalborg University Hospital, Aalborg, Denmark
| | - Ole B Christiansen
- Obstetrics and Gýnecology, Aalborg University Hospital, Aalborg, Denmark
| | - Niels Uldbjerg
- Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
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Bahado-Singh RO, Syngelaki A, Akolekar R, Mandal R, Bjondahl TC, Han B, Dong E, Bauer S, Alpay-Savasan Z, Graham S, Turkoglu O, Wishart DS, Nicolaides KH. Validation of metabolomic models for prediction of early-onset preeclampsia. Am J Obstet Gynecol 2015; 213:530.e1-530.e10. [PMID: 26116099 DOI: 10.1016/j.ajog.2015.06.044] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 05/13/2015] [Accepted: 06/16/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We sought to perform validation studies of previously published and newly derived first-trimester metabolomic algorithms for prediction of early preeclampsia (PE). STUDY DESIGN Nuclear magnetic resonance-based metabolomic analysis was performed on first-trimester serum in 50 women who subsequently developed early PE and in 108 first-trimester controls. Random stratification and allocation was used to divide cases into a discovery group (30 early PE and 65 controls) for generation of the biomarker model(s) and a validation group (20 early PE and 43 controls) to ensure an unbiased assessment of the predictive algorithms. Cross-validation testing on the different algorithms was performed to confirm their robustness before use. Metabolites, demographic features, clinical characteristics, and uterine Doppler pulsatility index data were evaluated. Area under the receiver operator characteristic curve (AUC), 95% confidence interval (CI), sensitivity, and specificity of the biomarker models were derived. RESULTS Validation testing found that the metabolite-only model had an AUC of 0.835 (95% CI, 0.769-0.941) with a 75% sensitivity and 74.4% specificity and for the metabolites plus uterine Doppler pulsatility index model it was 0.916 (95% CI, 0.836-0.996), 90%, and 88.4%, respectively. Predictive metabolites included arginine and 2-hydroxybutyrate, which are known to be involved in vascular dilation, and insulin resistance and impaired glucose regulation, respectively. CONCLUSION We found confirmatory evidence that first-trimester metabolomic biomarkers can predict future development of early PE.
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Ridding G, Hyett JA, Sahota D, McLennan AC. Assessing quality standards in measurement of uterine artery pulsatility index at 11 to 13 + 6 weeks' gestation. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:299-305. [PMID: 25412757 DOI: 10.1002/uog.14732] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 11/13/2014] [Accepted: 11/13/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To assess the effect of audit and feedback on the performance of first-trimester uterine artery pulsatility index (UtA-PI) measurement, to determine whether operator experience affects performance and whether an operator's measurement profile affects the screen-positive rate for early-onset pre-eclampsia (PE). METHODS This was a prospective cohort study in which UtA-PI measurements were collected between 11 to 13 + 6 weeks' gestation by 12 operators and were entered into individualized calculators to convert them to multiples of a locally-derived median (MoM). Individual sonographer cumulative sum (CUSUM) and target charts were generated to assess central tendency and dispersion to identify systematic measurement errors and deviation from expected measurement performance. Six of the operators received regular feedback whilst the remaining six received no feedback. Each group consisted of four experienced operators and two relatively inexperienced operators. The average MoM for each operator was compared with their respective screen-positive rates for early-onset PE. RESULTS The group that received feedback performed better than that which received none, with results more closely matching the expected measurement distribution. UtA-PI measurements were comparable between the experienced and inexperienced sonographers (mean log10 lowest PI MoM, -0.0089 vs 0.0124, respectively); however the inexperienced sonographers had a higher overall screen-positive rate for early-onset PE (10.0% vs 2.7%, respectively). There was a significant positive correlation between the mean MoM for each operator and the screen-positive rate (r = 0.63). CONCLUSIONS CUSUM and target graphs are an effective method of audit for first-trimester UtA-PI measurement. Feedback to operators resulted in improved measurement performance, which will ultimately result in improved screening accuracy for PE.
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Affiliation(s)
- G Ridding
- Northern Clinical School, University of Sydney, Sydney, Australia
| | - J A Hyett
- Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine, University of Sydney, Sydney, Australia
- Department of High Risk Obstetrics, Royal Prince Alfred Hospital, Sydney, Australia
| | - D Sahota
- Department of Obstetrics and Gynaecology, Chinese University of Hong Kong, Hong Kong, China
| | - A C McLennan
- Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine, University of Sydney, Sydney, Australia
- Sydney Ultrasound For Women, Sydney, Australia
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Promising prognostic markers of Preeclampsia: New avenues in waiting. Thromb Res 2015; 136:189-95. [DOI: 10.1016/j.thromres.2015.05.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 05/12/2015] [Accepted: 05/12/2015] [Indexed: 12/28/2022]
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First-trimester uterine artery Doppler analysis in the prediction of later pregnancy complications. DISEASE MARKERS 2015; 2015:679730. [PMID: 25972623 PMCID: PMC4418013 DOI: 10.1155/2015/679730] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 04/01/2015] [Indexed: 11/25/2022]
Abstract
Uterine artery Doppler waveform analysis has been extensively studied in the second trimester of pregnancy as a predictive marker for the later development of preeclampsia and fetal growth restriction. The use of Doppler interrogation of this vessel in the first trimester has gained momentum in recent years. Various measurement techniques and impedance indices have been used to evaluate the relationship between uterine artery Doppler velocimetry and adverse pregnancy outcomes. Overall, first-trimester Doppler interrogation of the uterine artery performs better in the prediction of early-onset than late-onset preeclampsia. As an isolated marker of future disease, its sensitivity in predicting preeclampsia and fetal growth restriction in low risk pregnant women is moderate, at 40–70%. Multiparametric predictive models, combining first-trimester uterine artery pulsatility index with maternal characteristics and biochemical markers, can achieve a detection rate for early-onset preeclampsia of over 90%. The ideal combination of these tests and validation of them in various patient populations will be the focus of future research.
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Brunelli VB, Prefumo F. Quality of first trimester risk prediction models for pre-eclampsia: a systematic review. BJOG 2015; 122:904-14. [DOI: 10.1111/1471-0528.13334] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2015] [Indexed: 12/12/2022]
Affiliation(s)
- VB Brunelli
- Department of Obstetrics and Gynaecology; University of Brescia; Brescia Italy
| | - F Prefumo
- Department of Obstetrics and Gynaecology; University of Brescia; Brescia Italy
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Santillan MK, Santillan DA, Scroggins SM, Min JY, Sandgren JA, Pearson NA, Leslie KK, Hunter SK, Zamba GKD, Gibson-Corley KN, Grobe JL. Vasopressin in preeclampsia: a novel very early human pregnancy biomarker and clinically relevant mouse model. Hypertension 2014; 64:852-9. [PMID: 25001273 PMCID: PMC4162750 DOI: 10.1161/hypertensionaha.114.03848] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 06/17/2014] [Indexed: 01/10/2023]
Abstract
Preeclampsia, a cardiovascular disorder of late pregnancy, is characterized as a low-renin hypertensive state relative to normotensive pregnancy. Because other nonpregnant low-renin hypertensive disorders often exhibit and are occasionally dependent on elevated arginine vasopressin (AVP) secretion, we hypothesized a possible use for plasma AVP measurements in the prediction of preeclampsia. Copeptin is an inert prosegment of AVP that is secreted in a 1:1 molar ratio and exhibits a substantially longer biological half-life compared with AVP, rendering it a clinically useful biomarker of AVP secretion. Copeptin was measured throughout pregnancy in maternal plasma from preeclamptic and control women. Maternal plasma copeptin was significantly higher throughout preeclamptic pregnancies versus control pregnancies. While controlling for clinically significant confounders (age, body mass index, chronic essential hypertension, twin gestation, diabetes mellitus, and history of preeclampsia) using multivariate regression, the association of higher copeptin concentration and the development of preeclampsia remained significant. Receiver operating characteristic analyses reveal that as early as the sixth week of gestation, elevated maternal plasma copeptin concentration is a highly significant predictor of preeclampsia throughout pregnancy. Finally, chronic infusion of AVP during pregnancy (24 ng per hour) is sufficient to phenocopy preeclampsia in C57BL/6J mice, causing pregnancy-specific hypertension, renal glomerular endotheliosis, proteinuria, and intrauterine growth restriction. These data implicate AVP release as a novel predictive biomarker for preeclampsia very early in pregnancy, identify chronic AVP infusion as a novel and clinically relevant model of preeclampsia in mice, and are consistent with a potential causative role for AVP in preeclampsia in humans.
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Affiliation(s)
- Mark K Santillan
- From the Departments of Obstetrics and Gynecology (M.K.S., D.A.S., S.M.S., K.K.L., S.K.H.), Pharmacology (J.Y.M., J.A.S., N.A.P., J.L.G.), Biostatistics (G.K.D.Z.), and Pathology (K.N.G.-C.), The François M. Abboud Cardiovascular Research Center (M.K.S., J.L.G.), The Obesity Research and Education Initiative (M.K.S., J.L.G.), The Fraternal Order of Eagles' Diabetes Research Center (J.L.G.), and The Center for Hypertension Research (M.K.S., J.L.G.). University of Iowa, Iowa City.
| | - Donna A Santillan
- From the Departments of Obstetrics and Gynecology (M.K.S., D.A.S., S.M.S., K.K.L., S.K.H.), Pharmacology (J.Y.M., J.A.S., N.A.P., J.L.G.), Biostatistics (G.K.D.Z.), and Pathology (K.N.G.-C.), The François M. Abboud Cardiovascular Research Center (M.K.S., J.L.G.), The Obesity Research and Education Initiative (M.K.S., J.L.G.), The Fraternal Order of Eagles' Diabetes Research Center (J.L.G.), and The Center for Hypertension Research (M.K.S., J.L.G.). University of Iowa, Iowa City
| | - Sabrina M Scroggins
- From the Departments of Obstetrics and Gynecology (M.K.S., D.A.S., S.M.S., K.K.L., S.K.H.), Pharmacology (J.Y.M., J.A.S., N.A.P., J.L.G.), Biostatistics (G.K.D.Z.), and Pathology (K.N.G.-C.), The François M. Abboud Cardiovascular Research Center (M.K.S., J.L.G.), The Obesity Research and Education Initiative (M.K.S., J.L.G.), The Fraternal Order of Eagles' Diabetes Research Center (J.L.G.), and The Center for Hypertension Research (M.K.S., J.L.G.). University of Iowa, Iowa City
| | - James Y Min
- From the Departments of Obstetrics and Gynecology (M.K.S., D.A.S., S.M.S., K.K.L., S.K.H.), Pharmacology (J.Y.M., J.A.S., N.A.P., J.L.G.), Biostatistics (G.K.D.Z.), and Pathology (K.N.G.-C.), The François M. Abboud Cardiovascular Research Center (M.K.S., J.L.G.), The Obesity Research and Education Initiative (M.K.S., J.L.G.), The Fraternal Order of Eagles' Diabetes Research Center (J.L.G.), and The Center for Hypertension Research (M.K.S., J.L.G.). University of Iowa, Iowa City
| | - Jeremy A Sandgren
- From the Departments of Obstetrics and Gynecology (M.K.S., D.A.S., S.M.S., K.K.L., S.K.H.), Pharmacology (J.Y.M., J.A.S., N.A.P., J.L.G.), Biostatistics (G.K.D.Z.), and Pathology (K.N.G.-C.), The François M. Abboud Cardiovascular Research Center (M.K.S., J.L.G.), The Obesity Research and Education Initiative (M.K.S., J.L.G.), The Fraternal Order of Eagles' Diabetes Research Center (J.L.G.), and The Center for Hypertension Research (M.K.S., J.L.G.). University of Iowa, Iowa City
| | - Nicole A Pearson
- From the Departments of Obstetrics and Gynecology (M.K.S., D.A.S., S.M.S., K.K.L., S.K.H.), Pharmacology (J.Y.M., J.A.S., N.A.P., J.L.G.), Biostatistics (G.K.D.Z.), and Pathology (K.N.G.-C.), The François M. Abboud Cardiovascular Research Center (M.K.S., J.L.G.), The Obesity Research and Education Initiative (M.K.S., J.L.G.), The Fraternal Order of Eagles' Diabetes Research Center (J.L.G.), and The Center for Hypertension Research (M.K.S., J.L.G.). University of Iowa, Iowa City
| | - Kimberly K Leslie
- From the Departments of Obstetrics and Gynecology (M.K.S., D.A.S., S.M.S., K.K.L., S.K.H.), Pharmacology (J.Y.M., J.A.S., N.A.P., J.L.G.), Biostatistics (G.K.D.Z.), and Pathology (K.N.G.-C.), The François M. Abboud Cardiovascular Research Center (M.K.S., J.L.G.), The Obesity Research and Education Initiative (M.K.S., J.L.G.), The Fraternal Order of Eagles' Diabetes Research Center (J.L.G.), and The Center for Hypertension Research (M.K.S., J.L.G.). University of Iowa, Iowa City
| | - Stephen K Hunter
- From the Departments of Obstetrics and Gynecology (M.K.S., D.A.S., S.M.S., K.K.L., S.K.H.), Pharmacology (J.Y.M., J.A.S., N.A.P., J.L.G.), Biostatistics (G.K.D.Z.), and Pathology (K.N.G.-C.), The François M. Abboud Cardiovascular Research Center (M.K.S., J.L.G.), The Obesity Research and Education Initiative (M.K.S., J.L.G.), The Fraternal Order of Eagles' Diabetes Research Center (J.L.G.), and The Center for Hypertension Research (M.K.S., J.L.G.). University of Iowa, Iowa City
| | - Gideon K D Zamba
- From the Departments of Obstetrics and Gynecology (M.K.S., D.A.S., S.M.S., K.K.L., S.K.H.), Pharmacology (J.Y.M., J.A.S., N.A.P., J.L.G.), Biostatistics (G.K.D.Z.), and Pathology (K.N.G.-C.), The François M. Abboud Cardiovascular Research Center (M.K.S., J.L.G.), The Obesity Research and Education Initiative (M.K.S., J.L.G.), The Fraternal Order of Eagles' Diabetes Research Center (J.L.G.), and The Center for Hypertension Research (M.K.S., J.L.G.). University of Iowa, Iowa City
| | - Katherine N Gibson-Corley
- From the Departments of Obstetrics and Gynecology (M.K.S., D.A.S., S.M.S., K.K.L., S.K.H.), Pharmacology (J.Y.M., J.A.S., N.A.P., J.L.G.), Biostatistics (G.K.D.Z.), and Pathology (K.N.G.-C.), The François M. Abboud Cardiovascular Research Center (M.K.S., J.L.G.), The Obesity Research and Education Initiative (M.K.S., J.L.G.), The Fraternal Order of Eagles' Diabetes Research Center (J.L.G.), and The Center for Hypertension Research (M.K.S., J.L.G.). University of Iowa, Iowa City
| | - Justin L Grobe
- From the Departments of Obstetrics and Gynecology (M.K.S., D.A.S., S.M.S., K.K.L., S.K.H.), Pharmacology (J.Y.M., J.A.S., N.A.P., J.L.G.), Biostatistics (G.K.D.Z.), and Pathology (K.N.G.-C.), The François M. Abboud Cardiovascular Research Center (M.K.S., J.L.G.), The Obesity Research and Education Initiative (M.K.S., J.L.G.), The Fraternal Order of Eagles' Diabetes Research Center (J.L.G.), and The Center for Hypertension Research (M.K.S., J.L.G.). University of Iowa, Iowa City.
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Gurgel Alves JA, Praciano de Sousa PC, Bezerra Maia E Holanda Moura S, Kane SC, da Silva Costa F. First-trimester maternal ophthalmic artery Doppler analysis for prediction of pre-eclampsia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 44:411-418. [PMID: 24585555 DOI: 10.1002/uog.13338] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 02/11/2014] [Accepted: 02/11/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To determine the performance of a multiparametric test comprising maternal risk factors, uterine artery Doppler and ophthalmic artery Doppler in the first trimester of pregnancy for the prediction of pre-eclampsia (PE). METHODS This prospective observational cohort study recruited patients in the first trimester of pregnancy. Maternal uterine artery and ophthalmic artery Doppler assessments were performed in 440 singleton pregnancies at 11-14 weeks of gestation. Additional history was obtained through participant questionnaires, and follow-up occurred to discharge postdelivery. The normotensive and pre-eclamptic groups were compared using parametric (Student's t-test) and non-parametric (Mann-Whitney U-test) tests. Univariable and multivariable logistic regression analyses were performed to determine which biophysical factors, and which of the factors among the maternal characteristics and medical and obstetric history, had a significant contribution to the prediction of PE in a multiparametric model. RESULTS Thirty-one (7%) patients developed PE, including nine (2%) who required delivery before 34 weeks (early PE) and 22 (5%) with late PE. There were statistically significant differences in uterine artery pulsatility index (UtA-PI) and ophthalmic artery first diastolic peak (PD1) mean values between the PE and control groups. In a multiparametric model, both UtA-PI and PD1 achieved a 67% detection rate for early PE, although when combined, the detection rate only increased to 68%. CONCLUSIONS The efficiency of ophthalmic artery PD1 in the first trimester as a predictive marker for the later development of PE was approximately equal to that described for uterine artery Doppler. Although these findings do not support the replacement of uterine artery Doppler analysis in multiparametric predictive models for PE, they do provide novel insights into first-trimester maternal systemic vascular changes that precede the clinical development of this condition.
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Affiliation(s)
- J A Gurgel Alves
- Department of Public Health, State University of Ceará, Fortaleza, Ceará, Brazil
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Oliveira N, Magder LS, Blitzer MG, Baschat AA. First-trimester prediction of pre-eclampsia: external validity of algorithms in a prospectively enrolled cohort. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 44:279-85. [PMID: 24913190 DOI: 10.1002/uog.13435] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 05/22/2014] [Accepted: 05/23/2014] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To evaluate the performance of published first-trimester prediction algorithms for pre-eclampsia (PE) in a prospectively enrolled cohort of women. METHOD A MEDLINE search identified first-trimester screening-prediction algorithms for early-onset (requiring delivery < 34 weeks) and late-onset (requiring delivery ≥ 34 weeks) PE. Maternal variables, ultrasound parameters and biomarkers were determined prospectively in singleton pregnancies enrolled between 9 and 14 weeks. Prediction algorithms were applied to this population to calculate predicted probabilities for PE. The performance of the prediction algorithms was compared with that in the original publication and evaluated for factors explaining differences in prediction. RESULTS Six early and two late PE prediction algorithms were applicable to 871-2962 women, depending on the variables required. The prevalence of early PE was 1.0-1.2% and of late PE was 4.1-5.0% in these patient subsets. One early PE prediction algorithm performed better than in the original publication (80% detection rate (DR) of early PE for 10% false-positive rate (FPR)); the remaining five prediction algorithms underperformed (29-53% DR). Prediction algorithms for late PE also underperformed (18-31% DR, 10% FPR). Applying the screening cut-offs based on the highest Youden index probability scores correctly detected 40-80% of women developing early PE and 71-82% who developed late PE. Exclusion of patients on first-trimester aspirin resulted in DRs of 40-83% and 65-82% for early and late PE, respectively. CONCLUSION First-trimester prediction algorithms for PE share a high negative predictive value if applied to an external population but underperform in their ability to correctly identify women who develop PE. Further research is required to determine the factors responsible for the suboptimal external validity.
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Affiliation(s)
- N Oliveira
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
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42
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Oliveira N, Doyle LE, Atlas RO, Jenkins CB, Blitzer MG, Baschat AA. External validity of first-trimester algorithms in the prediction of pre-eclampsia disease severity. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 44:286-292. [PMID: 24912952 DOI: 10.1002/uog.13433] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 05/22/2014] [Accepted: 05/30/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To compare disease features in women with pre-eclampsia between those who are correctly identified (true positive) and those who are missed (false negative) when applying first-trimester prediction algorithms for pre-eclampsia to a prospectively enrolled population. METHOD Six first-trimester early (requiring delivery < 34 weeks' gestation) pre-eclampsia algorithms were applied to a prospective cohort of singleton pregnancies enrolled at first-trimester screening. Maternal outcomes, neonatal outcomes and severity parameters for pre-eclampsia were compared between true-positive and false-negative predictions. RESULTS Twenty of 2446 (0.8%) women developed early pre-eclampsia, with 65% of these developing severe features and 20% HELLP syndrome. At enrollment, true-positive cases were more likely to be African-American and chronically hypertensive, while false-negative cases were more likely to be Caucasian. At delivery, true-positive cases were more likely to have pre-eclampsia superimposed on hypertension, severely elevated blood pressure and creatinine level > 1.1 mg/dL. False-negative cases were more likely to have HELLP syndrome (all P < 0.05). CONCLUSION In an urban population with a high prevalence of chronic hypertension, patients who are correctly identified by first-trimester screening models are more likely to develop pre-eclampsia superimposed on chronic hypertension with severely elevated blood pressure and evidence of renal failure. In contrast, patients who are missed by these algorithms are more likely to have HELLP syndrome. Further research is needed to confirm these findings and the algorithm adjustments that may be necessary to better predict pre-eclampsia phenotypes.
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Affiliation(s)
- N Oliveira
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
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Mone F, McAuliffe FM. Low-dose aspirin and calcium supplementation for the prevention of pre-eclampsia. ACTA ACUST UNITED AC 2014. [DOI: 10.1111/tog.12111] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Fionnuala Mone
- UCD School of Medicine and Medical Science; University College Dublin; National Maternity Hospital; Holles St. Dublin Ireland
| | - Fionnuala M McAuliffe
- UCD School of Medicine and Medical Science; University College Dublin; National Maternity Hospital; Holles St. Dublin Ireland
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Ohkuchi A, Hirashima C, Takahashi K, Shirasuna K, Suzuki H, Ariga H, Kobayashi M, Hirose N, Matsubara S, Suzuki M. A trio of risk factors for the onset of preeclampsia in the second and early third trimesters. Pregnancy Hypertens 2014; 4:224-30. [DOI: 10.1016/j.preghy.2014.04.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 03/10/2014] [Accepted: 04/06/2014] [Indexed: 11/28/2022]
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Modulation of blood pressure response to exercise by physical activity and relationship with resting blood pressure during pregnancy. J Hypertens 2014; 32:1450-7; discussion 1457. [DOI: 10.1097/hjh.0000000000000185] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Svirsky R, Yagel S, Ben-Ami I, Cuckle H, Klug E, Maymon R. First trimester markers of preeclampsia in twins: maternal mean arterial pressure and uterine artery Doppler pulsatility index. Prenat Diagn 2014; 34:956-60. [DOI: 10.1002/pd.4402] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 04/29/2014] [Accepted: 04/30/2014] [Indexed: 11/06/2022]
Affiliation(s)
- R. Svirsky
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel, affiliated with the Sackler School of Medicine; Tel-Aviv University; Tel-Aviv Israel
| | - S. Yagel
- Division of Obstetrics and Gynecology; Hadassah-Hebrew University Medical Centers; Jerusalem Israel
| | - I. Ben-Ami
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel, affiliated with the Sackler School of Medicine; Tel-Aviv University; Tel-Aviv Israel
| | - H. Cuckle
- Sackler Faculty of Medicine; Tel-Aviv University; Tel-Aviv Israel
- Columbia University Medical Center; New York NY USA
- Reproductive Epidemiology; University of Leeds; Leeds UK
| | - E. Klug
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel, affiliated with the Sackler School of Medicine; Tel-Aviv University; Tel-Aviv Israel
| | - R. Maymon
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel, affiliated with the Sackler School of Medicine; Tel-Aviv University; Tel-Aviv Israel
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Parra-Cordero M, Sepúlveda-Martínez A, Preisler J, Pastén J, Soto-Chacón E, Valdés E, Rencoret G. Role of the glucose tolerance test as a predictor of preeclampsia. Gynecol Obstet Invest 2014; 78:130-5. [PMID: 24903217 DOI: 10.1159/000358876] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 01/20/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine whether oral glucose tolerance tests (OGTT) play a role as predictors of preeclampsia (PET) in pregnant women. METHODS A retrospective case-control study was conducted in 2,002 singleton pregnancies that had a uterine artery (UtA) Doppler at 22-25 weeks and an OGTT. The UtA Doppler and OGTT were adjusted based on maternal characteristics, and the results were expressed as multiples of the expected normal median and compared between groups. Logistic regression analysis was used to determine whether maternal characteristics, OGTT, and UtA Doppler significantly contribute to the prediction of early- (<34 weeks), intermediate- (34-37 weeks), or late-onset (>37 weeks) PET. The performance of the screening was determined by ROC curves. RESULTS Women who developed PET were characterized by an older maternal age, an increased body mass index, and an altered UtA Doppler. The group with intermediate-onset PET was the only one associated with higher 2-hour OGTT levels compared to controls. Combined models were developed via logistic regression analysis using maternal characteristics, UtA Doppler, and OGTT to predict PET. These combined models were able to detect around 74, 42, and 21% of women who later developed early-, intermediate-, or late-onset PET, respectively, with only a 5% false-positive rate. CONCLUSIONS This study shows that the combination of maternal characteristics, second-trimester UtA Doppler, and OGTT is a predictor of the development of PET in healthy pregnant women.
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Affiliation(s)
- M Parra-Cordero
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, University of Chile Hospital, Santiago, Chile
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Khalil A, Garcia-Mandujano R, Maiz N, Elkhouli M, Nicolaides KH. Longitudinal changes in uterine artery Doppler and blood pressure and risk of pre-eclampsia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 43:541-547. [PMID: 24265180 DOI: 10.1002/uog.13257] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 11/07/2013] [Accepted: 11/12/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To investigate longitudinal changes in the uterine artery mean pulsatility index (UtA-PI) and mean arterial pressure (MAP) in women who develop pre-eclampsia (PE) and gestational hypertension (GH). METHODS This was a prospective longitudinal study of singleton pregnancies identified by screening at 11 + 0 to 13 + 6 weeks' gestation as being at high risk for PE. Measurements of UtA-PI and MAP were taken every 4 weeks until delivery and were compared in women who developed preterm PE, requiring delivery before 37 weeks, term PE and GH with those in women who remained normotensive. RESULTS In the normal outcome group, UtA-PI decreased with gestational age and MAP decreased between 12 and 24 weeks and then increased. In the preterm PE group, as compared to the normal group, UtA-PI and MAP were higher from early pregnancy onward and the difference for both increased with gestational age. In the term PE group, UtA-PI was significantly increased only from 33 weeks onward and MAP was increased from 12 weeks onward but the difference from normal did not increase with gestation. In GH, UtA-PI did not differ significantly from normal but MAP was higher from 12 weeks onward. CONCLUSION The study describes temporal changes in UtA-PI and MAP in normal pregnancies and in women who develop PE and GH.
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Affiliation(s)
- A Khalil
- Department of Fetal Medicine, Institute for Women's Health, University College London Hospitals, London, UK
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Farina A. Biophysical markers for abnormal placentation: first and/or second trimester. Prenat Diagn 2014; 34:628-34. [DOI: 10.1002/pd.4377] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 03/27/2014] [Accepted: 04/02/2014] [Indexed: 11/10/2022]
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Crovetto F, Figueras F, Triunfo S, Crispi F, Rodriguez-Sureda V, Peguero A, Dominguez C, Gratacos E. Added value of angiogenic factors for the prediction of early and late preeclampsia in the first trimester of pregnancy. Fetal Diagn Ther 2014; 35:258-66. [PMID: 24714555 DOI: 10.1159/000358302] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 12/26/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To explore the predictive role of angiogenic factors for the prediction of early and late preeclampsia (PE) in the first trimester. METHODS A nested case-control study, within a cohort of 5,759 pregnancies, including 28 cases of early, 84 of late PE (cut-off 34 weeks) and 84 controls. Maternal characteristics, mean blood pressure (MAP), uterine artery (UtA) Doppler (11-13 weeks), vascular endothelial growth factor, placental growth factor (PlGF), soluble Fms-like tyrosine kinase-1 (sFlt-1) and soluble endoglin (8-11 weeks) were measured/recorded. All parameters were normalized by logarithmic transformation; logistic regression analysis was used to predict PE. RESULTS For early PE, significant contributions were chronic hypertension, previous PE, MAP, UtA Doppler, PlGF and sFlt-1. A model including these predictors achieved detection rates (DR) of 77.8 and 88.9% for 5 and 10% false-positive rates (FPR), respectively (AUC 0.958; 95% CI 0.920-0.996). For late PE, significant contributions were provided by body mass index, previous PE, UtA Doppler, PlGF and sFlt-1. The model including these factors achieved DR of 51.2 and 69% at 5 and 10% FPR, respectively (AUC 0.888; 95% CI 0.840-0.936). CONCLUSIONS Among angiogenic factors, not only PlGF but also sFlt-1 substantially improve the prediction for early and late PE. The data need confirmation in larger studies.
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Affiliation(s)
- Francesca Crovetto
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
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