Comparison of screening for pre-eclampsia at 31-34 weeks' gestation by sFlt-1/PlGF ratio and a method combining maternal factors with sFlt-1 and PlGF.
OBJECTIVE
To estimate the patient-specific risk of pre-eclampsia (PE) at 31-34 weeks' gestation by a combination of maternal characteristics and medical history with multiples of the median (MoM) values of serum placental growth factor (PlGF) and serum soluble fms-like tyrosine kinase-1 (sFlt-1) and to compare the performance of screening to that achieved by the sFlt-1/PlGF ratio.


METHODS
This was a prospective observational study in women attending a third-trimester ultrasound scan at 31-34 weeks as part of routine pregnancy care. We estimated the performance of screening for PE with delivery within 4 weeks of assessment and PE with delivery from 4 weeks after assessment up to 40 weeks' gestation by the sFlt-1/PlGF ratio and by a method utilizing Bayes' theorem that combines maternal factors and MoM values of sFlt-1 and PlGF. The significance of the difference in screening performance between the two methods was assessed by comparison of the areas under the receiver-operating characteristics curves (AUC).


RESULTS
The study population of 8063 singleton pregnancies included 231 (2.9%) that subsequently developed PE. In the prediction of delivery with PE at < 4 weeks from assessment, the performance of the method utilizing Bayes' theorem was similar to that using the sFlt-1/PlGF ratio (AUC, 0.987 (95% CI, 0.979-0.995) vs 0.988 (95% CI, 0.981-0.994); P = 0.961). In contrast, the performance of screening for delivery with PE at ≥ 4 weeks after assessment up to 40 weeks' gestation was better with the method utilizing Bayes' theorem than that with the sFlt-1/PlGF ratio (AUC, 0.884 (95% CI, 0.854-0.914) vs 0.818 (95% CI, 0.775-0.860); P < 0.0001).


CONCLUSIONS
At 31-34 weeks' gestation the performance of screening for PE delivering at < 4 weeks from assessment by the method utilizing Bayes' theorem is similar to that using the sFlt-1/PlGF ratio, but the former is superior to the latter in prediction of PE delivering ≥ 4 weeks from assessment. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
M Y
MY
Tan
Institute of Health Research, University of Exeter, Exeter, UK.
D
D
Wright
Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
L
L
Koutoulas
Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.|Department of Fetal Medicine, Medway Maritime Hospital, Gillingham, UK.
R
R
Akolekar
Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
K H
KH
Nicolaides
D000328:Adult; D005260:Female; D006801:Humans; D000072483:Placenta Growth Factor / Q000097:blood*; D011225:Pre-Eclampsia / Q000000981:diagnostic imaging* / Q000378:metabolism; D011247:Pregnancy; D011263:Pregnancy Trimester, Third / Q000097:blood*; D011446:Prospective Studies; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal; D040281:Vascular Endothelial Growth Factor Receptor-1 / Q000097:blood*
C000608036:PGF protein, human; D000072483:Placenta Growth Factor; C501162:FLT1 protein, human; D040281:Vascular Endothelial Growth Factor Receptor-1
placental growth factor; pre-eclampsia; pyramid of antenatal care; soluble fms-like tyrosine kinase-1