title: First-trimester maternal ophthalmic artery Doppler analysis for prediction of pre-eclampsia.
abstract: OBJECTIVE
  To determine the performance of a multiparametric test comprising maternal risk factors, uterine artery Doppler and ophthalmic artery Doppler in the first trimester of pregnancy for the prediction of pre-eclampsia (PE).
  
  
  METHODS
  This prospective observational cohort study recruited patients in the first trimester of pregnancy. Maternal uterine artery and ophthalmic artery Doppler assessments were performed in 440 singleton pregnancies at 11-14 weeks of gestation. Additional history was obtained through participant questionnaires, and follow-up occurred to discharge postdelivery. The normotensive and pre-eclamptic groups were compared using parametric (Student's t-test) and non-parametric (Mann-Whitney U-test) tests. Univariable and multivariable logistic regression analyses were performed to determine which biophysical factors, and which of the factors among the maternal characteristics and medical and obstetric history, had a significant contribution to the prediction of PE in a multiparametric model.
  
  
  RESULTS
  Thirty-one (7%) patients developed PE, including nine (2%) who required delivery before 34 weeks (early PE) and 22 (5%) with late PE. There were statistically significant differences in uterine artery pulsatility index (UtA-PI) and ophthalmic artery first diastolic peak (PD1) mean values between the PE and control groups. In a multiparametric model, both UtA-PI and PD1 achieved a 67% detection rate for early PE, although when combined, the detection rate only increased to 68%.
  
  
  CONCLUSIONS
  The efficiency of ophthalmic artery PD1 in the first trimester as a predictive marker for the later development of PE was approximately equal to that described for uterine artery Doppler. Although these findings do not support the replacement of uterine artery Doppler analysis in multiparametric predictive models for PE, they do provide novel insights into first-trimester maternal systemic vascular changes that precede the clinical development of this condition.
authors.affiliation: Department of Public Health, State University of Ceará, Fortaleza, Ceará, Brazil.
authors.forename: J A
authors.initials: JA
authors.lastname: Gurgel Alves
authors.forename: P C
authors.initials: PC
authors.lastname: Praciano de Sousa
authors.forename: S
authors.initials: S
authors.lastname: Bezerra Maia E Holanda Moura
authors.forename: S C
authors.initials: SC
authors.lastname: Kane
authors.forename: F
authors.initials: F
authors.lastname: da Silva Costa
mesh_terms: D000328:Adult; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D006801:Humans; D009880:Ophthalmic Artery / Q000000981:diagnostic imaging*; D011225:Pre-Eclampsia / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D018617:Ultrasonography, Doppler, Pulsed / Q000379:methods*; D055988:Uterine Artery / Q000000981:diagnostic imaging
keywords: Doppler sonography; first-trimester screening; ophthalmic artery; pregnancy; uterine artery Doppler