title: Efficiency of first-trimester uterine artery Doppler, a-disintegrin and metalloprotease 12, pregnancy-associated plasma protein a, and maternal characteristics in the prediction of preeclampsia.
abstract: OBJECTIVE
  The purpose of this study was to estimate the efficiency of first-trimester uterine artery Doppler, A-disintegrin and metalloprotease 12 (ADAM12), pregnancy-associated plasma protein A (PAPP-A), and maternal characteristics in the prediction of preeclampsia.
  
  
  METHODS
  We conducted a prospective cohort study of patients presenting for first-trimester aneuploidy screening between 11 and 14 weeks' gestation. Maternal serum ADAM12 and PAPP-A levels were measured by an immunoassay, and mean uterine artery Doppler pulsatility indices were calculated. Outcomes of interest included preeclampsia, early preeclampsia (defined as requiring delivery at <34 weeks' gestation), and gestational hypertension. Logistic regression analysis was used to model the prediction of preeclampsia using ADAM12 multiples of the median (MoM), PAPP-A MoM, and uterine artery Doppler pulsatility index MoM, either individually or in combination. The sensitivity, specificity, and area under the receiver operating characteristic curves were used to compare the screening efficiency of the models using nonparametric U statistics.
  
  
  RESULTS
  Among 578 patients with complete outcome data, there were 54 cases of preeclampsia (9.3%) and 13 cases of early preeclampsia (2.2%). Median ADAM12 levels were significantly lower in patients who developed preeclampsia compared to those who did not (0.81 versus 1.01 MoM; P = .04). For a fixed false-positive rate of 10%, ADAM12, PAPP-A, and uterine artery Doppler parameters in combination with maternal characteristics identified 50%, 48%, and 52% of patients who developed preeclampsia, respectively. Combining these first-trimester parameters did not improve the predictive efficiency of the models.
  
  
  CONCLUSIONS
  First-trimester ADAM12, PAPP-A, and uterine artery Doppler characteristics are not sufficiently predictive of preeclampsia. Combinations of these parameters do not further improve their screening efficiency.
authors: Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO 63110, USA. goetzingerk@wudosis.wustl.edu
authors: Katherine R
authors: KR
authors: Goetzinger
authors: Yan
authors: Y
authors: Zhong
authors: Alison G
authors: AG
authors: Cahill
authors: Linda
authors: L
authors: Odibo
authors: George A
authors: GA
authors: Macones
authors: Anthony O
authors: AO
authors: Odibo
mesh_terms: D051722:ADAM Proteins / Q000097:blood*; D000328:Adult; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D053508:Matrix Metalloproteinase 12 / Q000097:blood*; D008923:Missouri / Q000453:epidemiology; D011225:Pre-Eclampsia / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology; D011247:Pregnancy; D011261:Pregnancy Trimester, First / Q000097:blood; D011266:Pregnancy-Associated Plasma Protein-A / Q000032:analysis*; D015995:Prevalence; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity; D018608:Ultrasonography, Doppler / Q000706:statistics & numerical data*; D055988:Uterine Artery / Q000000981:diagnostic imaging*
chemical_list: D015415:Biomarkers; D051722:ADAM Proteins; D011266:Pregnancy-Associated Plasma Protein-A; D053508:Matrix Metalloproteinase 12; C579283:PAPPA protein, human
keywords: A-disintegrin and metalloprotease 12; placental dysfunction; preeclampsia; pregnancy-associated plasma protein A; uterine artery Doppler sonography
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