title: Accuracy of competing-risks model in screening for pre-eclampsia by maternal factors and biomarkers at 11-13 weeks' gestation.
abstract: OBJECTIVE
  To examine the diagnostic accuracy of a previously developed model for prediction of pre-eclampsia (PE) by a combination of maternal factors and biomarkers at 11-13 weeks' gestation.
  
  
  METHODS
  This was a prospective first-trimester multicenter study of screening for PE in 8775 singleton pregnancies. A previously published algorithm was used for the calculation of patient-specific risk of PE in each individual. The detection rates (DRs) and false-positive rates (FPRs) for delivery with PE < 32, < 37 and ≥ 37 weeks were estimated and compared with those for the dataset used for development of the algorithm.
  
  
  RESULTS
  In the study population, 239 (2.7%) cases developed PE, of which 17 (0.2%), 59 (0.7%) and 180 (2.1%) developed PE < 32, < 37 and ≥ 37 weeks, respectively. With combined screening by maternal factors, mean arterial pressure, uterine artery pulsatility index and serum placental growth factor, the DR was 100% (95% CI, 80-100%) for PE < 32 weeks, 75% (95% CI, 62-85%) for PE < 37 weeks and 43% (95% CI, 35-50%) for PE ≥ 37 weeks, at a 10% FPR. These DRs were similar to the estimated rates for the dataset used for development of the model: 89% (95% CI, 79-96%) for PE < 32 weeks, 75% (95% CI, 70-80%) for PE < 37 weeks and 47% (95% CI, 44-51%) for PE ≥ 37 weeks.
  
  
  CONCLUSIONS
  Assessment of a combination of maternal factors and biomarkers at 11-13 weeks provides effective first-trimester screening for preterm PE. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
authors.affiliation: Harris Birthright Centre for Fetal Medicine, King's College Hospital, London, UK.
authors.forename: N
authors.initials: N
authors.lastname: O'Gorman
authors.affiliation: Institute of Health Research, University of Exeter, Exeter, UK.
authors.forename: D
authors.initials: D
authors.lastname: Wright
authors.affiliation: Harris Birthright Centre for Fetal Medicine, King's College Hospital, London, UK.|Chinese University of Hong Kong, Hong Kong, China.
authors.forename: L C
authors.identifier: http://orcid.org/0000-0002-3944-4130
authors.initials: LC
authors.lastname: Poon
authors.affiliation: Harris Birthright Centre for Fetal Medicine, King's College Hospital, London, UK.
authors.forename: D L
authors.initials: DL
authors.lastname: Rolnik
authors.affiliation: Harris Birthright Centre for Fetal Medicine, King's College Hospital, London, UK.
authors.forename: A
authors.identifier: http://orcid.org/0000-0001-5856-6072
authors.initials: A
authors.lastname: Syngelaki
authors.affiliation: Institute of Health Research, University of Exeter, Exeter, UK.
authors.forename: A
authors.initials: A
authors.lastname: Wright
authors.affiliation: Harris Birthright Centre for Fetal Medicine, King's College Hospital, London, UK.|Medway Maritime Hospital, Gillingham, UK.
authors.forename: R
authors.initials: R
authors.lastname: Akolekar
authors.affiliation: Homerton University Hospital, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Cicero
authors.affiliation: North Middlesex University Hospital, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Janga
authors.affiliation: Centre Hospitalier Universitaire Brugmann, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: Jani
authors.affiliation: Hospital Universitario San Cecilio, Granada, Spain.
authors.forename: F S
authors.initials: FS
authors.lastname: Molina
authors.affiliation: Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.
authors.forename: C
authors.initials: C
authors.lastname: de Paco Matallana
authors.affiliation: Attikon University Hospital, Athens, Greece.
authors.forename: N
authors.initials: N
authors.lastname: Papantoniou
authors.affiliation: Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Persico
authors.affiliation: Hospiten Group, Tenerife, Canary Islands, Spain.
authors.forename: W
authors.initials: W
authors.lastname: Plasencia
authors.affiliation: Southend University Hospital, Essex, UK.
authors.forename: M
authors.initials: M
authors.lastname: Singh
authors.affiliation: Harris Birthright Centre for Fetal Medicine, King's College Hospital, London, UK.
authors.forename: K H
authors.initials: KH
authors.lastname: Nicolaides
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood*; D005060:Europe; D005260:Female; D005865:Gestational Age; D006801:Humans; D008962:Models, Theoretical; D000072483:Placenta Growth Factor / Q000097:blood*; D011225:Pre-Eclampsia / Q000097:blood / Q000175:diagnosis*; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011296:Prenatal Diagnosis; D011446:Prospective Studies; D011673:Pulsatile Flow; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D055988:Uterine Artery / Q000502:physiology*
chemical_list: D015415:Biomarkers; D000072483:Placenta Growth Factor
keywords: Bayes' theorem; first-trimester screening; mean arterial pressure; placental growth factor; pre-eclampsia; pregnancy-associated plasma protein-A; pyramid of pregnancy care; survival model; uterine artery Doppler