title: A novel three-step approach for predicting the imminent onset of preeclampsia within 4 weeks after blood sampling at 19-31 weeks of gestation.
abstract: Our aim was to develop a novel screening method to detect the imminent onset of preeclampsia (PE) within 4 weeks after blood sampling. We prospectively collected data regarding past history of PE/gestational hypertension (GH), blood pressure levels at 16-23 weeks and plasma levels of soluble fms-like tyrosine kinase 1 (sFlt-1) and placental growth factor (PlGF) twice at 19-31 weeks, which were measured using an automated electrochemiluminescence immunoassay. We found that a three-step approach by sequential selection using maternal factors, including a past history of PE/GH or blood pressure levels ≥120/80 mm Hg at 16-23 weeks (first step), followed by plasma levels of PlGF in the <5th percentile (second step) and plasma levels of sFlt-1 in the ≥95th percentile (third step) yielded both high sensitivity and specificity. The imminent onset of PE occurred in 2 of 1199 (0.2%) women recruited at 19-25 weeks and in 6 of 798 (0.8%) women recruited at 26-31 weeks. The sensitivity, specificity, positive likelihood ratio (95% confidence interval), negative likelihood ratio (95% confidence interval), positive predictive value and negative predictive value of the three-step approach for predicting the imminent onset of PE at 19-25 weeks were 100%, 99.8%, 599 (150-2390), 0%, 50% and 100%, respectively; and those at 26-31 weeks were 83%, 99.1%, 94 (42-214), 0.17 (0.03-1.01), 42% and 99.9%, respectively. In conclusion, the three-step approach is a highly sensitive and specific screening method for detecting the imminent onset of PE within 4 weeks after blood sampling at 19-31 weeks of gestation.
authors.affiliation: Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine, Tochigi, Japan.
authors.forename: Chikako
authors.initials: C
authors.lastname: Hirashima
authors.affiliation: Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine, Tochigi, Japan.
authors.forename: Akihide
authors.initials: A
authors.lastname: Ohkuchi
authors.affiliation: Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine, Tochigi, Japan.
authors.forename: Kayo
authors.initials: K
authors.lastname: Takahashi
authors.affiliation: Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine, Tochigi, Japan.
authors.forename: Hirotada
authors.initials: H
authors.lastname: Suzuki
authors.affiliation: Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine, Tochigi, Japan.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Matsubara
authors.affiliation: Department of Obstetrics and Gynecology, Jichi Medical University School of Medicine, Tochigi, Japan.
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Suzuki
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure / Q000502:physiology; D005260:Female; D006403:Hematologic Tests; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D000072483:Placenta Growth Factor; D011225:Pre-Eclampsia / Q000097:blood* / Q000175:diagnosis* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000097:blood* / Q000175:diagnosis* / Q000503:physiopathology; D011257:Pregnancy Proteins / Q000097:blood; D011262:Pregnancy Trimester, Second / Q000097:blood* / Q000502:physiology; D011263:Pregnancy Trimester, Third / Q000097:blood* / Q000502:physiology; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D040281:Vascular Endothelial Growth Factor Receptor-1 / Q000097:blood
chemical_list: D015415:Biomarkers; C000608036:PGF protein, human; D011257:Pregnancy Proteins; D000072483:Placenta Growth Factor; C501162:FLT1 protein, human; D040281:Vascular Endothelial Growth Factor Receptor-1