title: First trimester screening for intra-uterine growth restriction and early-onset pre-eclampsia.
abstract: OBJECTIVE
  To assess first trimester placental growth factor (PlGF) and pregnancy-associated plasma protein-A (PAPP-A) as screening markers for early-onset pre-eclampsia (PE) and intra-uterine growth restriction (IUGR).
  
  
  METHODS
  PlGF concentration was retrospectively measured in first trimester serum specimens of 23 cases of early-onset PE (<34 weeks), 26 cases of IUGR (birth weight < 5th centile) and 5 controls per case. Levels were adjusted for gestational age (GA), ethnicity and smoking to obtain multiples of the expected median (MoM). Logistic regression was used to assess PlGF, PAPP-A and maternal characteristics as potential predictors of early-onset PE and IUGR.
  
  
  RESULTS
  PlGF MoM levels were significantly lower in the early-onset PE group (P < 0.0001) compared with controls, but not in the IUGR group. PAPP-A MoM levels were significantly lower in the IUGR group (P < 0.01) compared with controls but not in the early-onset PE group. PlGF significantly improved the ability of systolic blood pressure at the first prenatal visit to predict early-onset PE [achieving a receiver-operating characteristics curve with area under the curve (AUC) of 0.8]. Combining systolic blood pressure at the first prenatal visit and PlGF did not significantly improve the predictive ability compared with PlGF alone (AUC = 0.83).
  
  
  CONCLUSIONS
  Serum PlGF is an acceptable marker in first trimester screening for early-onset PE, but a poor marker in screening for IUGR. Screening performance of serum PAPP-A is poor for both early-onset PE and IUGR.
authors: Department of Obstetrics & Gynecology, VU University Medical Center, Amsterdam, the Netherlands. griet.vandenberghe@uzgent.be
authors: G
authors: G
authors: Vandenberghe
authors: I
authors: I
authors: Mensink
authors: J W R
authors: JW
authors: Twisk
authors: M A
authors: MA
authors: Blankenstein
authors: A C
authors: AC
authors: Heijboer
authors: J M G
authors: JM
authors: van Vugt
mesh_terms: D000328:Adult; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D042241:Early Diagnosis; D005260:Female; D005317:Fetal Growth Retardation / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D005865:Gestational Age; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D009426:Netherlands / Q000453:epidemiology; D000072483:Placenta Growth Factor; D011225:Pre-Eclampsia / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D011237:Predictive Value of Tests; D011247:Pregnancy; D011257:Pregnancy Proteins / Q000097:blood; D011261:Pregnancy Trimester, First / Q000097:blood; D011266:Pregnancy-Associated Plasma Protein-A / Q000378:metabolism; D011296:Prenatal Diagnosis / Q000379:methods*; D012372:ROC Curve; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; C000608036:PGF protein, human; D011257:Pregnancy Proteins; D000072483:Placenta Growth Factor; D011266:Pregnancy-Associated Plasma Protein-A