Hypertensive disorders in pregnancy: screening by biophysical and biochemical markers at 11-13 weeks.
OBJECTIVE
To examine the performance of screening for pre-eclampsia (PE) and gestational hypertension (GH) by a combination of maternal factors and various biophysical and biochemical markers at 11-13 weeks' gestation.


METHODS
This was a case-control study of 26 cases of early PE, 90 of late PE, 85 of GH and 201 unaffected controls. Maternal history was recorded, the uterine artery with the lowest pulsatility index (L-PI) and mean arterial pressure (MAP) were measured and stored plasma and serum were analyzed for placental growth factor (PlGF), inhibin-A, activin-A, tumor necrosis factor receptor-1, matrix metalloproteinase-9, pentraxin-3 and P-selectin.


RESULTS
Multivariate logistic regression analysis demonstrated that significant prediction for early PE was provided by maternal factors, MAP, uterine artery L-PI and serum PlGF. Significant prediction of late PE was provided by maternal factors, MAP, uterine artery L-PI, PlGF, activin-A and P-selectin. For GH significant prediction was provided by maternal factors, MAP, uterine artery L-PI and activin-A. In screening by a combination of maternal factors, biophysical and biochemical markers the estimated detection rates, at a 5% false-positive rate, were 88.5% (95% CI, 69.8-97.4%) for early PE, 46.7% (95% CI, 36.1-57.5%) for late PE and 35.3% (95% CI, 25.2-46.4%) for GH.


CONCLUSIONS
Combined biophysical and biochemical testing at 11-13 weeks could effectively identify women at high risk for subsequent development of hypertensive disorders in pregnancy.
Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
L C Y
LC
Poon
R
R
Akolekar
R
R
Lachmann
J
J
Beta
K H
KH
Nicolaides
D000328:Adult; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D005189:False Positive Reactions; D005260:Female; D005865:Gestational Age; D006801:Humans; D008403:Mass Screening / Q000379:methods; D011225:Pre-Eclampsia / Q000097:blood* / Q000000981:diagnostic imaging; D011247:Pregnancy; D011261:Pregnancy Trimester, First / Q000097:blood; D011266:Pregnancy-Associated Plasma Protein-A / Q000032:analysis*; D011673:Pulsatile Flow / Q000502:physiology*; D018608:Ultrasonography, Doppler; D055988:Uterine Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*
D015415:Biomarkers; D011266:Pregnancy-Associated Plasma Protein-A