Screening for preeclampsia using first-trimester serum markers and uterine artery Doppler in nulliparous women.
OBJECTIVE
To evaluate the screening accuracy of pregnancy hypertensive disorders by maternal serum biomarkers and uterine artery Doppler in the first trimester.


METHODS
Prospectively enrolled nulliparous women had uterine artery Doppler and serum measured at 11-13 weeks. Maternal characteristics, uterine artery Doppler, and serum placental biomarkers (pregnancy-associated plasma protein-A, Inhibin-A, placental protein 13, A disintegrin and metalloprotease 12, free β-hCG, placental growth factor) were recorded.


RESULTS
Among 893 women, 20 (2.2%) had gestational hypertension developed and 40 (4.5%) had preeclampsia developed, including 9 (1.0%) early-onset preeclampsia and 16 (1.8%) severe preeclampsia. A combined screening model with clinical characteristics, pregnancy-associated plasma protein-A, Inhibin-A, and placental growth factor could detect 75% of early-onset preeclampsia at a 10% false-positive rate. After adjustment for clinical variables, uterine artery Doppler, placental protein 13, and A disintegrin and metalloprotease 12 did not improve the diagnostic accuracy.


CONCLUSIONS
A combination of clinical characteristics and first-trimester maternal serum biomarkers (pregnancy-associated plasma protein-A, Inhibin-A, and placental growth factor) provides an accurate screening for early-onset preeclampsia in nulliparous women.
Audibert
François
F
Department of Obstetrics and Gynecology, CHU Sainte-Justine Research Center, Université de Montréal, Montreal, Canada.
Boucoiran
Isabelle
I
An
Na
N
Aleksandrov
Nikolai
N
Delvin
Edgard
E
Bujold
Emmanuel
E
Rey
Evelyne
E
D051722:ADAM Proteins / Q000097:blood; D000072199:ADAM12 Protein; D000328:Adult; D015415:Biomarkers / Q000097:blood; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D042241:Early Diagnosis; D005260:Female; D037161:Galectins; D006801:Humans; D007265:Inhibins / Q000097:blood; D016014:Linear Models; D008403:Mass Screening; D008565:Membrane Proteins / Q000097:blood; D010298:Parity; D000072483:Placenta Growth Factor; D011225:Pre-Eclampsia / Q000097:blood / Q000175:diagnosis*; D011247:Pregnancy; D011257:Pregnancy Proteins / Q000097:blood; D011261:Pregnancy Trimester, First; D011266:Pregnancy-Associated Plasma Protein-A / Q000032:analysis; D011446:Prospective Studies; D012372:ROC Curve; D012720:Severity of Illness Index; D012907:Smoking / Q000097:blood; D018608:Ultrasonography, Doppler; D055988:Uterine Artery / Q000000981:diagnostic imaging*
D015415:Biomarkers; D018997:Chorionic Gonadotropin, beta Subunit, Human; D037161:Galectins; C038195:LGALS13 protein, human; D008565:Membrane Proteins; C000608036:PGF protein, human; D011257:Pregnancy Proteins; C422362:inhibin A; D000072483:Placenta Growth Factor; D007265:Inhibins; D051722:ADAM Proteins; D000072199:ADAM12 Protein; C000606480:ADAM12 protein, human; D011266:Pregnancy-Associated Plasma Protein-A