title: Mid-trimester beta-hCG levels incorporated in a multifactorial model for the prediction of severe pre-eclampsia.
abstract: Pre-eclampsia remains a major cause of perinatal morbidity and mortality worldwide. Proposed predicting tests for early detection of pregnant women destined to develop pre-eclampsia remain unsatisfactory. The aim of this study was to investigate the clinical utility of combining mid-trimester maternal serum beta-human chorionic gonadotrophin (MShCG) levels with selected clinical determining factors as a multifactorial predictive test for pre-eclampsia. Thirty-nine cases with mild pre-eclampsia and 56 with severe pre-eclampsia were recruited as the study groups. Normotensive women (957) were enrolled as controls. Potential determining risk factors for severe pre-eclampsia were selected using a multiple logistic regression to build various combined prediction models. A receiver-operator characteristic curve was employed to assess the performance of each prediction test for pre-eclampsia. The prediction efficacy of each test was examined by the area under the curve (AUC). Our data show that mid-trimester MShCG levels significantly correlated with severity of pre-eclampsia (Spearman rank correlation coefficient=0.195, p<0.001). Women with mild pre-eclampsia had a 2.61-times greater chance, while women with severe pre-eclampsia had a 6.13-times greater chance of having MShCG exceeding 2.0 multiples of the median than did women with a normal pregnancy. A combined prediction model composed of MShCG levels, body mass index (BMI), parity, and age as a predictive test for severe pre-eclampsia was superior to MShCG levels alone (AUC 0.765 versus 0.648). The integrated multifactorial model could identify women at risk early on for developing severe pre-eclampsia, with a sensitivity of 70% and a specificity of 71%. Thus, we demonstrate a potentially effective and convenient method by which women at risk for developing severe pre-eclampsia can be identified early, based on a multifactorial predictive model composed of midtrimester MShCG levels, BMI, parity, and age.
authors.affiliation: Department of Obstetrics and Gynaecology, Taipei Municipal Women and Children's Hospital, Taipei, Taiwan.
authors.forename: L C
authors.initials: LC
authors.lastname: Lee
authors.forename: B C
authors.initials: BC
authors.lastname: Sheu
authors.forename: W Y
authors.initials: WY
authors.lastname: Shau
authors.forename: D M
authors.initials: DM
authors.lastname: Liu
authors.forename: T J
authors.initials: TJ
authors.lastname: Lai
authors.forename: Y H
authors.initials: YH
authors.lastname: Lee
authors.forename: S C
authors.initials: SC
authors.lastname: Huang
mesh_terms: D000328:Adult; D019540:Area Under Curve; D015984:Causality; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood*; D005260:Female; D006801:Humans; D016015:Logistic Models; D011225:Pre-Eclampsia / Q000097:blood* / Q000453:epidemiology; D011237:Predictive Value of Tests; D011247:Pregnancy / Q000097:blood*; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D018997:Chorionic Gonadotropin, beta Subunit, Human