title: First trimester screening for early and late preeclampsia based on maternal characteristics, biophysical parameters, and angiogenic factors.
abstract: OBJECTIVE
  The aim of this article is to develop the best first-trimester screening model for preeclampsia (PE) based on maternal characteristics, biophysical parameters, and angiogenic factors in a low-risk population.
  
  
  METHODS
  A prospective cohort of 9462 pregnancies undergoing first-trimester screening is used. Logistic regression predictive models were developed for early and late PE (cut-off of 34 weeks' gestation at delivery). Data included the a priori risk (maternal characteristics), mean arterial pressure (MAP), and uterine artery (UtA) Doppler (11-13 weeks) in all cases. Plasma levels (8-11 weeks) of human chorionic gonadotrophin, pregnancy-associated plasma protein A, placental growth factor (PlGF), and soluble Fms-like tyrosine kinase-1 (sFlt-1) were analyzed using a nested case-control study design.
  
  
  RESULTS
  The best model for early PE (n = 57, 0.6%) included a priori risk, MAP, UtA Doppler, PlGF, and sFlt-1 achieving detection rates of 87.7% and 91.2% for 5% and 10% false-positive rates, respectively (AUC: 0.98 [95% CI: 0.97-0.99]). For late PE (n = 246, 2.6%), the best model included the a priori risk, MAP, UtA Doppler, PlGF, and sFlt-1 achieving detection rates of 68.3% and 76.4% at 5% and 10% of false-positive rates, respectively (AUC: 0.87 [95% CI: 0.84-0.90]).
  
  
  CONCLUSIONS
  Preeclampsia can be predicted with high accuracy in general obstetric populations with a low risk for PE, by combined algorithms. Angiogenic factors substantially improved the prediction.
authors.affiliation: BCNatal - (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain; Department of Obstetrics and Gynecology, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Crovetto
authors.forename: Francesc
authors.initials: F
authors.lastname: Figueras
authors.forename: Stefania
authors.initials: S
authors.lastname: Triunfo
authors.forename: Fatima
authors.initials: F
authors.lastname: Crispi
authors.forename: Victor
authors.initials: V
authors.lastname: Rodriguez-Sureda
authors.forename: Carmen
authors.initials: C
authors.lastname: Dominguez
authors.forename: Elisa
authors.initials: E
authors.lastname: Llurba
authors.forename: Eduard
authors.initials: E
authors.lastname: Gratacós
mesh_terms: D000328:Adult; D001794:Blood Pressure; D016022:Case-Control Studies; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D005260:Female; D006801:Humans; D008403:Mass Screening; D015999:Multivariate Analysis; D000072483:Placenta Growth Factor; D011225:Pre-Eclampsia / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011257:Pregnancy Proteins / Q000097:blood; D011261:Pregnancy Trimester, First; D011266:Pregnancy-Associated Plasma Protein-A / Q000378:metabolism; D014463:Ultrasonography; D055988:Uterine Artery / Q000000981:diagnostic imaging; D040281:Vascular Endothelial Growth Factor Receptor-1 / Q000097:blood
chemical_list: D018997:Chorionic Gonadotropin, beta Subunit, Human; C000608036:PGF protein, human; D011257:Pregnancy Proteins; D000072483:Placenta Growth Factor; D040281:Vascular Endothelial Growth Factor Receptor-1; D011266:Pregnancy-Associated Plasma Protein-A; C579283:PAPPA protein, human