title: A prospective study of screening for hypertensive disorders of pregnancy at 11-13 weeks in a Scandinavian population.
abstract: OBJECTIVE
  To investigate the prediction of preeclampsia and gestational hypertension using maternal characteristics, mean arterial pressure (MAP), uterine artery pulsatility index (UtAPI), pregnancy-associated plasma protein-A (PAPP-A) and placental growth factor (PlGF) at gestational weeks 11-13 in a Scandinavian population with a medium to high prior risk for developing hypertensive disorders of pregnancy.
  
  
  METHODS
  Prospective screening study.
  
  
  METHODS
  National Center for Fetal Medicine, Trondheim, Norway.
  
  
  METHODS
  579 women who were nulliparous or had a previous history of preeclampsia or gestational hypertension.
  
  
  METHODS
  Women were examined between 11(+0) and 13(+6) weeks, with interviews for maternal characteristics and measurements of MAP, UtAPI, PAPP-A and PlGF. The tests were evaluated separately and in combined models with receiver operating characteristics (ROC) curves.
  
  
  METHODS
  Prediction of preeclampsia, severe preeclampsia and gestational hypertension.
  
  
  RESULTS
  The best model for severe preeclampsia (MAP+UtAPI+PlGF+PAPP-A) achieved an area under the ROC curve of 0.866 [95% confidence interval (95% CI) 0.756-0.976]. The best models for preeclampsia (MAP+UtAPI+age) achieved 0.738 (0.634-0.841), gestational hypertension (MAP) 0.820 (0.727-0.913) and hypertensive disorders in pregnancy overall (MAP+PlGF+age) 0.783 (0.709-0.856). Using the best model we could identify 61.5% (95% CI 31.6-86.1) of severe preeclampsia, 38.5% (95% CI 20.2-59.4) of preeclampsia and 42.9% (95% CI 21.8-66) of gestational hypertension at a fixed 10% false-positive rate.
  
  
  CONCLUSIONS
  Maternal characteristics, MAP, UtAPI, PAPP-A and PlGF showed limited value as screening tests. Further research on biochemical and biophysical tests and algorithms combining these parameters is needed before first trimester screening for hypertensive disorders of pregnancy is included in antenatal care in Scandinavia.
authors.affiliation: Department of Laboratory Medicine Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; National Center for Fetal Medicine, Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
authors.forename: Ragnhild B
authors.initials: RB
authors.lastname: Skråstad
authors.forename: Gunhild G
authors.initials: GG
authors.lastname: Hov
authors.forename: Harm-Gerd K
authors.initials: HG
authors.lastname: Blaas
authors.forename: Pål R
authors.initials: PR
authors.lastname: Romundstad
authors.forename: Kjell Å
authors.initials: KÅ
authors.lastname: Salvesen
mesh_terms: D000328:Adult; D001794:Blood Pressure / Q000502:physiology; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D009664:Norway / Q000453:epidemiology; D016017:Odds Ratio; D000072483:Placenta Growth Factor; D011225:Pre-Eclampsia / Q000097:blood / Q000175:diagnosis*; D011247:Pregnancy; D011257:Pregnancy Proteins / Q000097:blood*; D011261:Pregnancy Trimester, First / Q000502:physiology; D011266:Pregnancy-Associated Plasma Protein-A / Q000032:analysis*; D011295:Prenatal Care / Q000379:methods; D011296:Prenatal Diagnosis / Q000379:methods*; D011446:Prospective Studies; D011673:Pulsatile Flow; D018570:Risk Assessment / Q000379:methods; D014463:Ultrasonography; D055988:Uterine Artery / Q000000981:diagnostic imaging*; D055815:Young Adult
chemical_list: C000608036:PGF protein, human; D011257:Pregnancy Proteins; D000072483:Placenta Growth Factor; D011266:Pregnancy-Associated Plasma Protein-A
keywords: Doppler; Preeclampsia; biomarkers; blood pressure; first trimester; screening; ultrasound; uterine artery