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Cowan S, Lang S, Goldstein R, Enticott J, Taylor F, Teede H, Moran LJ. Identifying Predictor Variables for a Composite Risk Prediction Tool for Gestational Diabetes and Hypertensive Disorders of Pregnancy: A Modified Delphi Study. Healthcare (Basel) 2024; 12:1361. [PMID: 38998895 PMCID: PMC11241067 DOI: 10.3390/healthcare12131361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 07/01/2024] [Accepted: 07/01/2024] [Indexed: 07/14/2024] Open
Abstract
A composite cardiometabolic risk prediction tool will support the systematic identification of women at increased cardiometabolic risk during pregnancy to enable early screening and intervention. This study aims to identify and select predictor variables for a composite risk prediction tool for cardiometabolic risk (gestational diabetes mellitus and/or hypertensive disorders of pregnancy) for use in the first trimester. A two-round modified online Delphi study was undertaken. A prior systematic literature review generated fifteen potential predictor variables for inclusion in the tool. Multidisciplinary experts (n = 31) rated the clinical importance of variables in an online survey and nominated additional variables for consideration (Round One). An online meeting (n = 14) was held to deliberate the importance, feasibility and acceptability of collecting variables in early pregnancy. Consensus was reached in a second online survey (Round Two). Overall, 24 variables were considered; 9 were eliminated, and 15 were selected for inclusion in the tool. The final 15 predictor variables related to maternal demographics (age, ethnicity/race), pre-pregnancy history (body mass index, height, history of chronic kidney disease/polycystic ovarian syndrome, family history of diabetes, pre-existing diabetes/hypertension), obstetric history (parity, history of macrosomia/pre-eclampsia/gestational diabetes mellitus), biochemical measures (blood glucose levels), hemodynamic measures (systolic blood pressure). Variables will inform the development of a cardiometabolic risk prediction tool in subsequent research. Evidence-based, clinically relevant and routinely collected variables were selected for a composite cardiometabolic risk prediction tool for early pregnancy.
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Affiliation(s)
- Stephanie Cowan
- Monash Centre for Health Research and Implementation, School of Clinical Sciences, Monash University, Mulgrave, VIC 3170, Australia; (S.C.); (S.L.); (R.G.); (J.E.); (H.T.)
| | - Sarah Lang
- Monash Centre for Health Research and Implementation, School of Clinical Sciences, Monash University, Mulgrave, VIC 3170, Australia; (S.C.); (S.L.); (R.G.); (J.E.); (H.T.)
| | - Rebecca Goldstein
- Monash Centre for Health Research and Implementation, School of Clinical Sciences, Monash University, Mulgrave, VIC 3170, Australia; (S.C.); (S.L.); (R.G.); (J.E.); (H.T.)
- Monash Endocrine and Diabetes Units, Monash Health, Clayton, Melbourne, VIC 3168, Australia
| | - Joanne Enticott
- Monash Centre for Health Research and Implementation, School of Clinical Sciences, Monash University, Mulgrave, VIC 3170, Australia; (S.C.); (S.L.); (R.G.); (J.E.); (H.T.)
| | - Frances Taylor
- Monash Centre for Health Research and Implementation, School of Clinical Sciences, Monash University, Mulgrave, VIC 3170, Australia; (S.C.); (S.L.); (R.G.); (J.E.); (H.T.)
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Clinical Sciences, Monash University, Mulgrave, VIC 3170, Australia; (S.C.); (S.L.); (R.G.); (J.E.); (H.T.)
- Monash Endocrine and Diabetes Units, Monash Health, Clayton, Melbourne, VIC 3168, Australia
| | - Lisa J. Moran
- Monash Centre for Health Research and Implementation, School of Clinical Sciences, Monash University, Mulgrave, VIC 3170, Australia; (S.C.); (S.L.); (R.G.); (J.E.); (H.T.)
- Victorian Heart Institute, Monash Health, Clayton, Melbourne, VIC 3168, Australia
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Peris M, Crompton K, Shepherd DA, Amor DJ. The association between human chorionic gonadotropin and adverse pregnancy outcomes: a systematic review and meta-analysis. Am J Obstet Gynecol 2024; 230:118-184. [PMID: 37572838 DOI: 10.1016/j.ajog.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/28/2023] [Accepted: 08/02/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVE This study aimed to evaluate the association between human chorionic gonadotropin and adverse pregnancy outcomes. DATA SOURCES Medline, Embase, PubMed, and Cochrane were searched in November 2021 using Medical Subject Headings (MeSH) and relevant key words. STUDY ELIGIBILITY CRITERIA This analysis included published full-text studies of pregnant women with serum human chorionic gonadotropin testing between 8 and 28 weeks of gestation, investigating fetal outcomes (fetal death in utero, small for gestational age, preterm birth) or maternal factors (hypertension in pregnancy: preeclampsia, pregnancy-induced hypertension, placental abruption, HELLP syndrome, gestational diabetes mellitus). METHODS Studies were extracted using REDCap software. The Newcastle-Ottawa scale was used to assess for risk of bias. Final meta-analyses underwent further quality assessment using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) method. RESULTS A total of 185 studies were included in the final review, including the outcomes of fetal death in utero (45), small for gestational age (79), preterm delivery (62), hypertension in pregnancy (107), gestational diabetes mellitus (29), placental abruption (17), and HELLP syndrome (2). Data were analyzed separately on the basis of categorical measurement of human chorionic gonadotropin and human chorionic gonadotropin measured on a continuous scale. Eligible studies underwent meta-analysis to generate a pooled odds ratio (categorical human chorionic gonadotropin level) or difference in medians (human chorionic gonadotropin continuous scale) between outcome groups. First-trimester low human chorionic gonadotropin levels were associated with preeclampsia and fetal death in utero, whereas high human chorionic gonadotropin levels were associated with preeclampsia. Second-trimester high human chorionic gonadotropin levels were associated with fetal death in utero and preeclampsia. CONCLUSION Human chorionic gonadotropin levels are associated with placenta-mediated adverse pregnancy outcomes. Both high and low human chorionic gonadotropin levels in the first trimester of pregnancy can be early warning signs of adverse outcomes. Further analysis of human chorionic gonadotropin subtypes and pregnancy outcomes is required to determine the diagnostic utility of these findings in reference to specific cutoff values.
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Affiliation(s)
- Monique Peris
- Neurodisability and Rehabilitation Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, Australia
| | - Kylie Crompton
- Neurodisability and Rehabilitation Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, Australia
| | - Daisy A Shepherd
- Neurodisability and Rehabilitation Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - David J Amor
- Neurodisability and Rehabilitation Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, Australia.
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Górczewski W, Górecka J, Massalska-Wolska M, Staśkiewicz M, Borowski D, Huras H, Rybak-Krzyszkowska M. Role of First Trimester Screening Biochemical Markers to Predict Hypertensive Pregnancy Disorders and SGA Neonates-A Narrative Review. Healthcare (Basel) 2023; 11:2454. [PMID: 37685488 PMCID: PMC10487207 DOI: 10.3390/healthcare11172454] [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: 06/09/2023] [Revised: 07/24/2023] [Accepted: 08/03/2023] [Indexed: 09/10/2023] Open
Abstract
Early recognition of high-risk pregnancies through biochemical markers may promote antenatal surveillance, resulting in improved pregnancy outcomes. The goal of this study is to evaluate the possibilities of using biochemical markers during the first trimester of pregnancy in the prediction of hypertensive pregnancy disorders (HPD) and the delivery of small-for-gestational-age (SGA) neonates. A comprehensive search was conducted on key databases, including PubMed, Scopus, and Web of Science, for articles relating to the use of biochemical markers in the prediction of HPD and SGA. The findings show that changes in the levels of biomarkers in the early pregnancy phases could be an important indicator of adverse pregnancy outcomes. The literature shows that low PAPP-A (pregnancy-associated plasma protein A) and PlGF (placental growth factor) levels, low alkaline phosphatase (AP), higher sFlt-1 (soluble fms-like Tyrosine Kinase-1) levels, higher AFP (alfa fetoprotein) levels, and elevated levels of inflammatory markers such as β-HGC (free beta human chorionic gonadotropin), interferon-gamma (INF-γ), and tumor necrosis factor-α (TNF-α) may be associated with risks including the onset of HPD, fetal growth restriction (FGR), and delivery of SGA neonates. Comparatively, PAPP-A and PlGF appear to be the most important biochemical markers for the prediction of SGA and HPD.
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Affiliation(s)
- Wojciech Górczewski
- Independent Public Health Care Facility “Bl. Marta Wiecka County Hospital”, 32-700 Bochnia, Poland
| | - Joanna Górecka
- Department of Obstetrics and Perinatology, University Hospital, 31-501 Krakow, Poland
| | - Magdalena Massalska-Wolska
- Clinical Department of Gynecological Endocrinology and Gynecology, University Hospital, 31-501 Krakow, Poland
| | - Magdalena Staśkiewicz
- Department of Obstetrics and Perinatology, University Hospital, 31-501 Krakow, Poland
| | - Dariusz Borowski
- Clinic of Obstetrics and Gynecology, Provincial Combined Hospital in Kielce, 25-736 Kielce, Poland
| | - Hubert Huras
- Department of Obstetrics and Perinatology, Jagiellonian University Medical College, 31-501 Krakow, Poland
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Alekseenkova EN, Selkov SA, Kapustin RV. Fetal growth regulation via insulin-like growth factor axis in normal and diabetic pregnancy. J Perinat Med 2022; 50:947-960. [PMID: 35363447 DOI: 10.1515/jpm-2021-0510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 02/20/2022] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Diabetes mellitus (DM) in pregnancy and gestational diabetes remain a considerable cause of pregnancy complications, and fetal macrosomia is among them. Insulin, insulin-like growth factors (IGFs), and components of their signal-transduction axes belong to the predominant growth regulators and are implicated in glucose homeostasis. This study aimed to evaluate the available evidence on the association between the IGF axis and fetal anthropometric parameters in human diabetic pregnancy. METHODS PubMed, Medline, Web of Science, and CNKI databases (1981-2021) were searched. RESULTS Maternal and cord serum IGF-I levels are suggested to be positively associated with weight and length of neonates born to mothers with type 1 DM. The results concerning IGF-II and IGFBPs in type 1 DM or any of the IGF axis components in type 2 DM remain controversial. The alterations of maternal serum IGFs concentrations throughout diabetic and non-diabetic pregnancy do not appear to be the same. Maternal 1st trimester IGF-I level is positively associated with fetal birth weight in DM. CONCLUSIONS Research on the IGF axis should take gestational age of sampling, presence of DM, and insulin administration into account. Maternal 1st trimester IGF-I level might become a predictor for macrosomia development in diabetic pregnancy.
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Affiliation(s)
- Elena N Alekseenkova
- D.O. Ott Research Institute of Obstetrics, Gynecology, and Reproductive Medicine, St Petersburg, Russian Federation
| | - Sergey A Selkov
- D.O. Ott Research Institute of Obstetrics, Gynecology, and Reproductive Medicine, St Petersburg, Russian Federation
| | - Roman V Kapustin
- D.O. Ott Research Institute of Obstetrics, Gynecology, and Reproductive Medicine, St Petersburg, Russian Federation.,Department of Obstetrics, Gynecology and Reproduction, Faculty of Medicine, St Petersburg State University, St Petersburg, Russian Federation
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Genc S, Ozer H, Emeklioglu CN, Cingillioglu B, Sahin O, Akturk E, Sirinoglu HA, Basaran N, Mihmanli V. Relationship between extreme values of first trimester maternal pregnancy associated plasma Protein-A, free-β-human chorionic gonadotropin, nuchal translucency and adverse pregnancy outcomes. Taiwan J Obstet Gynecol 2022; 61:433-440. [PMID: 35595434 DOI: 10.1016/j.tjog.2022.02.043] [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] [Accepted: 02/07/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The aim of our study was to investigate the relationship between extreme values of first trimester screening markers and adverse obstetric outcomes. MATERIALS AND METHODS Our study was conducted by examining the prenatal and postnatal perinatal records of 786 singleton gestations between the ages of 18-40, who applied to Prof. Dr. Cemil Taşçıoğlu City Hospital outpatient clinics for first-trimester screening for aneuploidy, between January 1, 2017 and December 31, 2019. RESULTS The presence of small for gestational age (SGA) was found to be statistically significant for the <5 percentile (<0.37) pregnancy-associated plasma protein A (PAPP-A) group (p = 0.016). For <5 percentile β-hCG group, the presence of gestational diabetes mellitus (GDM), premature rupture of membrane (PROM) and preterm premature rupture of membrane (PPROM) was determined as a statistically significant risk (p = 0.015, p = 0.005, p = 0.02 respectively) In the univariate test, fetal death rate was found to be high for ≥90 percentile at nuchal translucency (NT), but the presence of fetal death was found to be statistically insignificant in logistic regression analysis. (p: 0.057). CONCLUSION First trimester screening test can be used in predicting pregnancy complications. In this study we found that serum levels of PAPP-A are associated with developing SGA, while GDM, PROM and PPROM are more common in low serum free β-hCG.
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Affiliation(s)
- Simten Genc
- Obstetrics and Gynecology Department Okmeydanı Training and Research Hospital Istanbul, Turkey (Prof. Dr. Cemil Tascıoglu City Hospital), Darulaceze Cad. No:25, Okmeydani, Sisli, 34384, Istanbul, Turkey.
| | - Hale Ozer
- Obstetrics and Gynecology Department Okmeydanı Training and Research Hospital Istanbul, Turkey (Prof. Dr. Cemil Tascıoglu City Hospital), Darulaceze Cad. No:25, Okmeydani, Sisli, 34384, Istanbul, Turkey.
| | - Cagdas Nurettin Emeklioglu
- Obstetrics and Gynecology Department Okmeydanı Training and Research Hospital Istanbul, Turkey (Prof. Dr. Cemil Tascıoglu City Hospital), Darulaceze Cad. No:25, Okmeydani, Sisli, 34384, Istanbul, Turkey.
| | - Basak Cingillioglu
- Obstetrics and Gynecology Department Okmeydanı Training and Research Hospital Istanbul, Turkey (Prof. Dr. Cemil Tascıoglu City Hospital), Darulaceze Cad. No:25, Okmeydani, Sisli, 34384, Istanbul, Turkey.
| | - Orhan Sahin
- Obstetrics and Gynecology Department Okmeydanı Training and Research Hospital Istanbul, Turkey (Prof. Dr. Cemil Tascıoglu City Hospital), Darulaceze Cad. No:25, Okmeydani, Sisli, 34384, Istanbul, Turkey.
| | - Erhan Akturk
- Obstetrics and Gynecology Department Okmeydanı Training and Research Hospital Istanbul, Turkey (Prof. Dr. Cemil Tascıoglu City Hospital), Darulaceze Cad. No:25, Okmeydani, Sisli, 34384, Istanbul, Turkey.
| | - Hicran Acar Sirinoglu
- Obstetrics and Gynecology Department Okmeydanı Training and Research Hospital Istanbul, Turkey (Prof. Dr. Cemil Tascıoglu City Hospital), Darulaceze Cad. No:25, Okmeydani, Sisli, 34384, Istanbul, Turkey.
| | - Nilgun Basaran
- Biochemistry Department Okmeydanı Training and Research Hospital Istanbul, Turkey (Prof. Dr. Cemil Tascıoglu City Hospital), Darulaceze Cad. No:25, Okmeydani, Sisli, 34384, Istanbul, Turkey.
| | - Veli Mihmanli
- Obstetrics and Gynecology Department Okmeydanı Training and Research Hospital Istanbul, Turkey (Prof. Dr. Cemil Tascıoglu City Hospital), Darulaceze Cad. No:25, Okmeydani, Sisli, 34384, Istanbul, Turkey.
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Ekelund CK, Rode L, Tabor A, Hyett J, McLennan A. Placental Growth Factor and Adverse Obstetric Outcomes in a Mixed-Risk Cohort of Women Screened for Preeclampsia in the First Trimester of Pregnancy. Fetal Diagn Ther 2021; 48:304-312. [PMID: 33789295 DOI: 10.1159/000514201] [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: 01/29/2020] [Accepted: 12/19/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The study aimed to investigate the association between placental growth factor (PlGF) and adverse obstetric outcomes in a mixed-risk cohort of pregnant women screened for preeclampsia (PE) in the first trimester. METHODS We included women with singleton pregnancies screened for PE between April 2014 and September 2016. Outcome data were retrieved from the New South Wales Perinatal Data Collection (NSW PDC) by linkage to the prenatal cohort. Adverse outcomes were defined as spontaneous preterm birth (sPTB) before 37-week gestation, birth weight (BW) below the 3rd centile, PE, gestational hypertension (GH), stillbirth, and neonatal death. RESULTS The cohort consisted of 11,758 women. PlGF multiple of the median (MoM) was significantly associated with maternal sociodemographic characteristics (particularly smoking status and parity) and all biomarkers used in the PE first trimester screening model (notably pregnancy-associated plasma protein A MoM and uterine artery pulsatility index [PI] MoM). Low levels of PlGF (<0.3 MoM and <0.5 MoM) were independently associated with sPTB, low BW, PE, GH, and a composite adverse pregnancy outcome score, with odds ratios between 1.81 and 4.44 on multivariable logistic regression analyses. CONCLUSIONS Low PlGF MoM levels are independently associated with PE and a range of other adverse pregnancy outcomes. Inclusion of PlGF should be considered in future models screening for adverse pregnancy outcomes in the first trimester.
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Affiliation(s)
- Charlotte Kvist Ekelund
- Department of Obstetrics, Center of Fetal Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark
| | - Line Rode
- Department of Clinical Biochemistry, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
| | - Ann Tabor
- Department of Obstetrics, Center of Fetal Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark
| | - Jon Hyett
- RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Andrew McLennan
- Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia.,Sydney Ultrasound for Women, Sydney, New South Wales, Australia
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Nogueira Reis ZS, Pereira JB, Costa LAC, Barra JS. Soluble endoglin in urine as an early-pregnancy preeclampsia marker: antenatal longitudinal feasibility study. J OBSTET GYNAECOL 2020; 41:693-698. [PMID: 32811216 DOI: 10.1080/01443615.2020.1789851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study aimed to evaluate soluble endoglin (sEng) in urine as a preeclampsia predictor. Ninety-three pregnant women at risk for preeclampsia were followed. Spot urine sample ELISA analysis before 20 weeks of gestation was done to assess protein levels. Logistic regression analysis evaluated associations between preeclampsia with sEng/creatinine ratio, pg/mg, adjusted for risk factors. Preeclampsia incidence was 22.8% (20/92). Urinary sEng/creatinine (pg/mg) 0.001 (95% CI 0.001-0.136) was associated, adjusted for body mass index > 28 kg/m2 OR 6.44 (95% CI 1.11-37.47) and mean arterial pressure OR 1.20 (1.07-1.35). During the first half of gestation sEng urinary excretion was lower in pregnant women developing preeclampsia.Impact statementWhat is already known on this subject? The angiogenesis factors present in the plasma of pregnant women have shown good preclinical predictors of preeclampsia. Studies on urinary markers in pregnancy are infrequent, despite the ease of obtaining urine specimens.What do the results of this study add? Values of the sEng/creatinine ratio during the first half of pregnancy were related to a higher chance of preeclampsia occurring when it was evaluated alone or adjusted by body mass index and mean arterial pressure values.What are the implications of these findings for clinical practice and/or further research? The potential benefits of a urinary test compared to one of the blood levels include its non-invasive nature and ease of performing the test, even during prenatal care. Future research is expected to evaluate the sEng/creatinine ratio relevance to improve clinical scores of preeclampsia prediction for the identification of women at risk for this disease.
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Affiliation(s)
- Zilma Silveira Nogueira Reis
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Jacqueline Braga Pereira
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Lúcia Aparecida C Costa
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Juliana Silva Barra
- Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Antwi E, Amoakoh-Coleman M, Vieira DL, Madhavaram S, Koram KA, Grobbee DE, Agyepong IA, Klipstein-Grobusch K. Systematic review of prediction models for gestational hypertension and preeclampsia. PLoS One 2020; 15:e0230955. [PMID: 32315307 PMCID: PMC7173928 DOI: 10.1371/journal.pone.0230955] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 03/12/2020] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Prediction models for gestational hypertension and preeclampsia have been developed with data and assumptions from developed countries. Their suitability and application for low resource settings have not been tested. This review aimed to identify and assess the methodological quality of prediction models for gestational hypertension and pre-eclampsia with reference to their application in low resource settings. METHODS Using combinations of keywords for gestational hypertension, preeclampsia and prediction models seven databases were searched to identify prediction models developed with maternal data obtained before 20 weeks of pregnancy and including at least three predictors (Prospero registration CRD 42017078786). Prediction model characteristics and performance measures were extracted using the CHARMS, STROBE and TRIPOD checklists. The National Institute of Health quality assessment tools for observational cohort and cross-sectional studies were used for study quality appraisal. RESULTS We retrieved 8,309 articles out of which 40 articles were eligible for review. Seventy-seven percent of all the prediction models combined biomarkers with maternal clinical characteristics. Biomarkers used as predictors in most models were pregnancy associated plasma protein-A (PAPP-A) and placental growth factor (PlGF). Only five studies were conducted in a low-and middle income country. CONCLUSIONS Most of the studies evaluated did not completely follow the CHARMS, TRIPOD and STROBE guidelines in prediction model development and reporting. Adherence to these guidelines will improve prediction modelling studies and subsequent application of prediction models in clinical practice. Prediction models using maternal characteristics, with good discrimination and calibration, should be externally validated for use in low and middle income countries where biomarker assays are not routinely available.
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Affiliation(s)
- Edward Antwi
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Ghana Health Service, Accra, Ghana
| | - Mary Amoakoh-Coleman
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Epidemiology Department, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Dorice L. Vieira
- New York University Health Sciences Library, New York University School of Medicine, New York, NY, United States of America
| | - Shreya Madhavaram
- New York University Health Sciences Library, New York University School of Medicine, New York, NY, United States of America
| | - Kwadwo A. Koram
- Epidemiology Department, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Diederick E. Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Kapustin RV, Kascheeva TK, Alekseenkova EN, Shelaeva EV. Are the first-trimester levels of PAPP-A and fb-hCG predictors for obstetrical complications in diabetic pregnancy? J Matern Fetal Neonatal Med 2020; 35:1113-1119. [PMID: 32228094 DOI: 10.1080/14767058.2020.1743658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: To assess the levels of pregnancy-associated plasma protein-A (PAPP-A) and β-human chorionic gonadotropin (fb-hCG) in cases of diabetic pregnancy, to determine whether these biomarkers can be considered significant predictors for macrosomia, preeclampsia (PE), intrauterine growth restriction (IUGR), and preterm birth in mothers with different types of pregestational diabetes mellitus (DM).Methods: It was a retrospective cohort study. Study groups were presented: type 1 DM (n = 100), type 2 DM (n = 50), and controls (n = 25). At 11 + 0 to 13 + 6 week's gestation, we recorded maternal characteristics and medical history, and performed a combined test for the detection of risk of chromosomal abnormalities. To assess the performance of the markers in the prediction of the main obstetrical complications (PE, IUGR, preterm birth, and macrosomia), receiver-operating characteristic (ROC) curves were produced and area under the curves was calculated.Results: The study has shown that DM is associated with a high rate of perinatal complications: PE, IUGR, macrosomia, and preterm birth. The median level of PAPP-A was significantly lower in case of type 1 DM- 0.89 (inter quartile range (IQR), 0.51-1.1), and type 2 DM-0.88 (IQR, 0.42-1.15) compared to the unaffected group 1.03 (IQR, 0.96-1.12; p = .025). There were no significant differences in the fb-hCG multiples of the normal median (MoM; p = .14) between the diabetic and unaffected groups. More significant results were obtained when calculated by percentile: in diabetic pregnancies, PAPP-A and fb-hCG MoMs values were lower in the 5-10% ranges and higher in the 95% range, compared to the control group. ROC-analysis did not show any significant data that first-trimester PAPP-A and fb-hCG serum levels are predictors for PE, IUGR, macrosomia, and preterm birth.Conclusion: The routine first-trimester serum screening of fetal Down syndrome cannot be used as a tool of risk identification for PE, IUGR, macrosomia, and preterm birth in case of diabetic pregnancy.
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Affiliation(s)
- Roman V Kapustin
- Department of Obstetrics, Division of Maternal-Fetal Medicine, D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductive Medicine, St. Petersburg, Russia.,Department of Obstetrics, Gynecology and Reproduction, Faculty of Medicine, St. Petersburg State University, St. Petersburg, Russia
| | - Tatyana K Kascheeva
- Department of Genetics, D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductive Medicine, St. Petersburg, Russia
| | - Elena N Alekseenkova
- Department of Obstetrics, Gynecology and Reproduction, Faculty of Medicine, St. Petersburg State University, St. Petersburg, Russia
| | - Elizaveta V Shelaeva
- Department of Obstetrics, Division of Maternal-Fetal Medicine, D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductive Medicine, St. Petersburg, Russia
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Honarjoo M, Kohan S, Zarean E, Tarrahi MJ. Assessment of β-human-derived chorionic gonadotrophic hormone (βhCG) and pregnancy-associated plasma protein A (PAPP-A) levels as predictive factors of preeclampsia in the first trimester among Iranian women: a cohort study. BMC Pregnancy Childbirth 2019; 19:464. [PMID: 31801467 PMCID: PMC6894335 DOI: 10.1186/s12884-019-2526-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 09/20/2019] [Indexed: 11/25/2022] Open
Abstract
Background Preeclampsia (PE) is a leading cause of maternal and perinatal mortality. There are controversial findings regarding the prediction of PE through the assessment of the Pregnancy-Associated Plasma Protein A (PAPP-A) and β-Human-Derived Chorionic Gonadotrophic hormone (βhCG) levels in the first trimester of pregnancy. Therefore, this cohort study was conducted to evaluate of PAPP-A and βhCG levels as predictive factors for PE development in the first trimester among Iranian women. Methods In this cohort study, a total of 4605 volunteer Primigravida and Multigravida women were selected by the census from 16 randomly selected Health Centers in Isfahan, Iran, from July 2016 to June 2018. Eligible pregnant women participated in the study had already undergone fetal anomalies screening tests between 11 + 0 and 13 + 6 weeks of pregnancy and their PAPP-A and βhCG biomarkers were adjusted to the Multiples of the Median (MOM). MOM PAPP-A < 0.4 and MOM βhCG > 3 were considered abnormal. The samples were followed up until delivery. The biomarkers’ levels were compared in the two groups of women with and without PE and Relative risk (RR) and odds ratio (OR) of PE calculated. Results In the PE group, the mean MOM PAPP-A was significantly lower (1 vs. 1.09 with P = 0.006) and MOM βhCG was significantly higher (1.51 vs. 1.14 with P = 0.001) than the group without PE. RR and OR for PE in subjects with MOM PAPP-A < 0.4 were reported as follows: RR = 2.49, (p = 0.001) and OR = 2.09, (p = 0.001). RR and OR for PE in subjects with MOM βhCG > 3 were also reported as follows: RR = 4.02, (p = 0.001) and OR = 5.65, (p = 0.001). Adjusted OR for MOM PAPP-A < 0.4 and MOM βhCG > 3 was obtained as follows: OR = 2.09 (P = 0.001) and OR = 5.65 (P = 0.001), respectively. Conclusion The results of the study showed that the high levels of βhCG would cause 5.65 times increase and the low levels of PAPP-A would cause 2.09 times increase in the chance of developing PE.
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Affiliation(s)
- Maryam Honarjoo
- Student research committee, School of nursing and midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shahnaz Kohan
- Associated professor, Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elahe Zarean
- Department of Obstetrics and Gynecology, Fetal Medicine Unit, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Javad Tarrahi
- Associated professor, Department of Epidemiology and Biostatistics, School of health, Isfahan University of Medical Sciences, Isfahan, Iran.
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Bækgaard Thorsen LH, Bjørkholt Andersen L, Birukov A, Lykkedegn S, Dechend R, Stener Jørgensen J, Thybo Christesen H. Prediction of birth weight small for gestational age with and without preeclampsia by angiogenic markers: an Odense Child Cohort study. J Matern Fetal Neonatal Med 2018; 33:1377-1384. [PMID: 30173595 DOI: 10.1080/14767058.2018.1519536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Purpose: To investigate the predictive performance of placental growth factor (PlGF) and soluble FMS-like kinase 1 (sFlt-1) on birth weight and small for gestational age (SGA), in a large, population-based cohort.Methods: Women enrolled in the population-based, prospective Odense Child Cohort Study with early (GA < 20 weeks) and/or late (≥20 weeks) pregnancy blood samples (n = 1937) were included. The association between log-transformed values of the biomarkers and birth weight Z-score was studied using multivariate regression models. The prediction of SGA overall, and in women developing preeclampsia, by biomarkers was evaluated using receiver operating characteristic analyses.Results: No substantial associations between early pregnancy biomarkers and SGA were seen. PlGF measured in late pregnancy demonstrated the strongest association with birth weight Z-score (adjusted β-coefficient = 0.43 [95%CI = 0.35; 0.50]). The area under curve (AUC) for predicting SGA was higher for sFlt-1/PlGF compared to sFlt-1 (0.74 versus 0.63, p = .006) and reached excellent prediction for SGA after preeclampsia (AUC 0.94). Optimal sFlt-1/PlGF ratio cut-offs had higher negative predictive value (NPV) and positive predictive value (PPV) for SGA (cut-off > 5.0; NPV = 99.1%, PPV = 5.4%) compared to each marker individually.Conclusion: The sFlt-1/PlGF ratio is a potential predictor of SGA in population-based screening, particularly when preeclampsia is also present.
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Affiliation(s)
- Lena Heidi Bækgaard Thorsen
- Hans Christian and Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Louise Bjørkholt Andersen
- Hans Christian and Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Department of Obstetrics and Gynecology, Herlev Hospital, Copenhagen, Denmark
| | - Anna Birukov
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark.,Experimental and Clinical Research Center, Max-Delbrück Center and Charité University Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Sine Lykkedegn
- Hans Christian and Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Ralf Dechend
- Experimental and Clinical Research Center, Max-Delbrück Center and Charité University Berlin, Berlin, Germany
| | - Jan Stener Jørgensen
- Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark.,Odense Child Cohort, Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Odense Patient Data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Henrik Thybo Christesen
- Hans Christian and Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Odense Child Cohort, Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Odense Patient Data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
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13
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Carrasco Falcón S, Vega Guedes B, Alvarado-Martel D, Wägner AM. Preconception care in diabetes: Predisposing factors and barriers. ACTA ACUST UNITED AC 2018; 65:164-171. [PMID: 29301729 DOI: 10.1016/j.endinu.2017.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 10/02/2017] [Accepted: 10/31/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND OBJECTIVE Preconception care has been shown to decrease the risk of pregnancy-related complications in women with diabetes, but many women do not plan their pregnancies. Our aim was to identify the associated factors and barriers related to involvement of these women in preconception care. MATERIAL AND METHODS Fifty women with pregestational diabetes (28 with type 1 diabetes) and 50 non-diabetic pregnant women were consecutively enrolled at our hospital. They completed a questionnaire, and their medical histories were reviewed. RESULTS All 33 patients with diabetes who received preconception care had a similar current age (34.3±5.3 years) and age at diagnosis (20.3±11.3) than those with no preconception care (n=17) (31.8±5.3 and 19.1±10.6 years respectively; P>.1), but were more frequently living with their partners (97% vs. 70.6%; P=.014), employed (69.7% vs. 29.4%; P=.047), and monitored by an endocrinologist (80.6% vs. 50%; P=.034), had more commonly had previous miscarriages (78.6% vs. 10%; P=.001), and knew the impact of diabetes on pregnancy (87.5% vs. 58.8%; P=.029). The frequency of preconceptional folic acid intake was similar in pregnant women with and without diabetes (23.8% vs. 32%; P>.1). CONCLUSIONS Preconception care of diabetic patients is associated to living with a partner, being employed, knowing the risks of pregnancy-related complications, having previous miscarriages, and being monitored by an endocrinologist. Pregnancy planning is infrequent in both women with and without diabetes.
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Affiliation(s)
| | - Begoña Vega Guedes
- Servicio de Ginecología y Obstetricia, Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Las Palmas de Gran Canaria, España; Instituto Universitario de Investigaciones Biomédicas y Sanitarias (IUIBS), Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España
| | - Dácil Alvarado-Martel
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias (IUIBS), Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España; Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Las Palmas de Gran Canaria, España
| | - Ana M Wägner
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias (IUIBS), Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España; Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Las Palmas de Gran Canaria, España.
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Breathett K, Filley J, Pandey M, Rai N, Peterson PN. Trends in Early Prenatal Care Among Women with Pre-Existing Diabetes: Have Income Disparities Changed? J Womens Health (Larchmt) 2018; 27:93-98. [PMID: 29023180 PMCID: PMC5771526 DOI: 10.1089/jwh.2016.6031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Women with pre-existing diabetes are at high maternal risk for comorbidities and death, particularly when early prenatal care is not received. Low income is a known barrier to early prenatal care. It is unknown whether recent policies to expand access to prenatal care have reduced income disparities. We hypothesized that income disparities would be minimized and that the odds of receipt of first trimester prenatal care among women with pre-existing diabetes would become similar across income strata over time. MATERIAL AND METHODS Using the Colorado birth certificate registry from 2007 to 2014, receipt of prenatal care was assessed retrospectively in 2,497 women with pre-existing diabetes. Logistic regression was used to examine the association between high (>$50,000), medium ($25,000-50,000), and low (<$25,000) income strata and receipt of first trimester prenatal care by birth year, adjusted for demographics. RESULTS High, medium, and low income represented 29.5%, 19.0%, and 51.5% of the cohort, respectively. Women with high income were more likely to receive first trimester care than women with low income from 2007 [adjusted odds ratio, 95% confidence interval: 2.16 (1.18, 3.96)] through 2013 [1.66 (1.01, 2.73)], but significant differences were no longer observed in 2014 [1.59 (0.89, 2.84)]. The likelihood of receiving first trimester prenatal care was not significantly different between medium- and low-income strata from 2007 [1.07 (0.66, 1.74)] through 2014 [0.77 (0.48, 1.23)]. CONCLUSIONS From 2007 to 2013, women in Colorado with diabetes were more likely to receive early prenatal care if they were in the highest income stratum than in the lowest stratum. In 2014, receipt of first trimester care became equitable across all income strata. Future work should examine national patterns of income with receipt of prenatal care and outcomes among women with pre-existing diabetes.
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Affiliation(s)
- Khadijah Breathett
- Division of Cardiology, Anschutz Medical Campus, University of Colorado, Aurora, Colorado
- Division of Cardiology, Sarver Heart Center, University of Arizona-Tucson, Tucson, Arizona
| | - Jessica Filley
- Department of Public Health, Anschutz Medical Campus, University of Colorado, Aurora, Colorado
| | - Madhaba Pandey
- Department of Public Health, Anschutz Medical Campus, University of Colorado, Aurora, Colorado
| | - Nayanjot Rai
- Department of Public Health, Anschutz Medical Campus, University of Colorado, Aurora, Colorado
| | - Pamela N. Peterson
- Division of Cardiology, Anschutz Medical Campus, University of Colorado, Aurora, Colorado
- Denver Health Medical Center, Denver, Colorado
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