title: First trimester screening of serum soluble fms-like tyrosine kinase-1 and placental growth factor predicting hypertensive disorders of pregnancy.
abstract: OBJECTIVE
  To assess the accuracy of first trimester soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) in predicting pregnancy hypertension and pre-eclampsia; and compare with the accuracy of routinely collected maternal and clinical risk factors.
  
  
  METHODS
  In this population-based cohort study, serum sFlt-1 and PlGF levels were measured in first trimester in 2,681 women with singleton pregnancies in New South Wales, Australia.
  
  
  METHODS
  Prediction of pregnancy hypertension and pre-eclampsia.
  
  
  RESULTS
  There were 213 (7.9%) women with pregnancy hypertension, including 68 (2.5%) with pre-eclampsia. The area under the curve (AUC) for both sFlt-1 and PlGF was not different from chance, but combined was 0.55 (P=0.005). Parity and previous diagnosed hypertension had better predictive accuracy than serum biomarkers (AUC=0.64, P<0.001) and the predictive accuracy for all maternal and clinical information was fair (AUC=0.70, P<0.001 for pregnancy hypertension and AUC=0.74, P<0.001 for pre-eclampsia). Adding sFlt-1 and PlGF to maternal risk factors did not improve the ability of the models to predict pregnancy hypertension or pre-eclampsia.
  
  
  CONCLUSIONS
  Maternal first trimester serum concentrations of sFlt-1 and PlGF do not predict hypertensive disorders in pregnancy any better than routinely collected clinical and maternal risk factor information. Screening for sFlt-1 and PlGF levels in early pregnancy would not identify those pregnancies at-risk.
authors.affiliation: Clinical and Population Perinatal Health Research, Kolling Institute of Medical Research, University of Sydney, Sydney, NSW, Australia. Electronic address: francisco.schneuer@sydney.edu.au.
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Schneuer
authors.affiliation: Clinical and Population Perinatal Health Research, Kolling Institute of Medical Research, University of Sydney, Sydney, NSW, Australia.
authors.forename: Natasha
authors.initials: N
authors.lastname: Nassar
authors.affiliation: Clinical and Population Perinatal Health Research, Kolling Institute of Medical Research, University of Sydney, Sydney, NSW, Australia.
authors.forename: Cyrille
authors.initials: C
authors.lastname: Guilbert
authors.affiliation: Fetal Maternal Medicine (PaLMs), Royal North Shore Hospital, St. Leonards, NSW, Australia.
authors.forename: Vitomir
authors.initials: V
authors.lastname: Tasevski
authors.affiliation: Clinical and Population Perinatal Health Research, Kolling Institute of Medical Research, University of Sydney, Sydney, NSW, Australia.
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Ashton
authors.affiliation: Clinical and Population Perinatal Health Research, Kolling Institute of Medical Research, University of Sydney, Sydney, NSW, Australia.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Morris
authors.affiliation: Clinical and Population Perinatal Health Research, Kolling Institute of Medical Research, University of Sydney, Sydney, NSW, Australia.
authors.forename: Christine L
authors.initials: CL
authors.lastname: Roberts
keywords: First trimester; Fms-like tyrosine kinase-1; Placental growth factor; Pre-eclampsia; Predictive accuracy; Pregnancy hypertension