MoM cutoffs for variables, an important tool for multivariate analysis and accurate interpretation of preeclampsia risk in high-risk pregnancy at 11-13+6weeks gestation.
OBJECTIVE
To determine the diagnostic accuracy of preeclampsia (PE) screening test offered in early pregnancy for the prediction of the risks for early-onset (requiring delivery <32 weeks gestation) and late-onset (requiring delivery ≥32 weeks gestation) disease.


METHODS
In a retrospective study of 615 women with singleton pregnancy, the risk for PE was calculated by the combined effect of multiple variables: serum placental growth factor (PLGF) and pregnancy-associated plasma protein-A (PAPP-A), maternal age, parity, ethnicity, mean arterial pressure (MAP), body mass index (BMI), uterine artery-pulsatility index, and previous history of PE or hypertension (HT). The results of the screening test in three different groups of women were validated by pregnancy outcome: (i) control group - without any history of PE/HT; (ii) history of PE without HT; and (iii) history of HT without PE. The performance of the screening test was evaluated for early- and late-onset PE.


RESULTS
The multivariate screening effectively identified cases of PE with >97% specificity. The detection rate (DR) was 93.8% for late-onset PE at a false positive rate (FPR) of 2.3% and 44.4% for early-onset PE at an FPR of 0.0%. The incidence of PE was 7% overall, with 1.52% and 5.43% for early- and late-onset PE, respectively.


CONCLUSIONS
The study demonstrated 96.6% diagnostic accuracy of the multi-variable screening test to predict the risk of PE in the first trimester. The negative predictive value (>98%) reinforces the utility of cost-effective noninvasive screening test for the early detection of PE.


BACKGROUND
PLGF: Placental growth factor; PAPP-A: Pregnancy-associated plasma protein-A; free β-HCG: Free beta-human chorionic gonadotropin; BMI: Body mass index; MAP: Mean arterial blood pressure; Ut-PI: Mean uterine artery pressure (left and right uterine artery)-pulsatility index; MoM: Multiple of median; NICE: National Institute for Health and Clinical Excellence.
a Center of Medical Genetics, Sir Ganga Ram Hospital , Rajinder Nagar , New Delhi , India.
Jyotsna
J
Verma
a Center of Medical Genetics, Sir Ganga Ram Hospital , Rajinder Nagar , New Delhi , India.
Divya C
DC
Thomas
a Center of Medical Genetics, Sir Ganga Ram Hospital , Rajinder Nagar , New Delhi , India.
Geetu
G
Jhingan
a Center of Medical Genetics, Sir Ganga Ram Hospital , Rajinder Nagar , New Delhi , India.
Ratna D
RD
Puri
a Center of Medical Genetics, Sir Ganga Ram Hospital , Rajinder Nagar , New Delhi , India.
I C
IC
Verma
D000328:Adult; D001794:Blood Pressure / Q000502:physiology*; D005260:Female; D006801:Humans; D015999:Multivariate Analysis; D011225:Pre-Eclampsia / Q000175:diagnosis* / Q000503:physiopathology; D011247:Pregnancy; D011261:Pregnancy Trimester, First / Q000502:physiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D055815:Young Adult
Biochemical screening; hypertension; multiple variable analysis; placental growth factor; preeclampsia