title: Identifying mild and severe preeclampsia in asymptomatic pregnant women by levels of cell-free fetal DNA.
abstract: BACKGROUND
  The objective was to investigate whether women who develop preeclampsia can be identified in a routine analysis when determining fetal RHD status at 25 weeks' gestation in combination with PAPP-A levels at the first-trimester combined risk assessment for Trisomy 21.
  
  
  METHODS
  D- women participating in the routine antenatal RHD screening program in the capital region of Denmark were retrospectively studied. We used a standard dilution curve to quantify the amounts of cell-free fetal DNA (cffDNA) and divided women into groups according to cffDNA levels. PAPP-A was measured at 11 to 14 weeks. Information about pregnancy outcome and complications was obtained from the National Fetal Medicine Database, medical charts, and discharge letters.
  
  
  RESULTS
  The odds ratio (OR) of developing severe preeclampsia given a cffDNA level above the 90th percentile compared to cffDNA below the 90th percentile was 8.1 (95% confidence interval [CI], 2.6-25.5). The OR of developing mild preeclampsia given a cffDNA level below the 5th percentile compared to cffDNA levels above the 5th percentile was 3.6 (95% CI, 1.1-11.7). PAPP-A levels below the 5th percentile were associated with mild preeclampsia, but adding it to the analysis did not increase the detection rate (DR).
  
  
  CONCLUSIONS
  Women with cffDNA levels below the 5th percentile and above the 90th percentile quantified at 25 weeks' gestation are at increased risk of developing preeclampsia. Adding PAPP-A levels to the analysis did not increase the DR of preeclampsia.
authors: Department of Fetal Medicine, 4002, Juliane Marie Center, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Immunology, 2034, Diagnostic Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors: Tanja Roien
authors: TR
authors: Jakobsen
authors: Frederik Banch
authors: FB
authors: Clausen
authors: Line
authors: L
authors: Rode
authors: Morten Hanefeld
authors: MH
authors: Dziegiel
authors: Ann
authors: A
authors: Tabor
mesh_terms: D000328:Adult; D004314:Down Syndrome / Q000235:genetics; D005260:Female; D005333:Fetus / Q000378:metabolism*; D006801:Humans; D011225:Pre-Eclampsia / Q000235:genetics*; D011247:Pregnancy; D011261:Pregnancy Trimester, First / Q000235:genetics; D011262:Pregnancy Trimester, Second; D011266:Pregnancy-Associated Plasma Protein-A / Q000378:metabolism; D012189:Retrospective Studies
chemical_list: D011266:Pregnancy-Associated Plasma Protein-A