55 Prediction of subtypes of pre-eclampsia in high-risk women

Abstract

Introduction Pre-eclampsia (PE) is a heterogeneous pregnancy-specific disorder. Prediction of different subtypes may require different strategies. Early identification of high-risk women would allow closer surveillance and application of preventive measures. Objectives To evaluate first-trimester biomarkers, mean arterial pressure (MAP), and pulsatility index (PI) of uterine artery (Uta) for the prediction of PE and its early- and late-onset forms (EOPE delivery Methods We studied a subcohort of 257 high-risk women with biomarker and blood pressure measurements available at 11 0/7–13 6/7 weeks of gestation. Placental growth factor (PlGF), human chorionic gonadotropin (hCG), hyperglycosylated hCG (hCG-h), hCG-beta and pregnancy associated plasma protein A (PAPP-A). Doppler ultrasound measurement was available at the same time point from 217 women (83.7%). The results are presented as multiples of the medians (MoMs). The binary logistic regression was used to evaluate univariate associations. Multivariable prediction models were built using regularized logistic regression with L1/L2-norm. Cross validation was used to select regularization variables and separately to assess model fit. Three separate models were fitted for all outcomes. The first model included only background variables and mean arterial pressure in the first trimester (model 1), then biomarkers (model 2) and MoM of mean PI of Uta was added (model 3). Areas under ROC (receiver operating characteristics) curves (AUC) were determined for all models and compared using R package pROC. Results Nine women developed EOPE (3.5%) and 25 LOPE (13.2%). In univariate analyses low PlGF, high MAP and high Uta PI were associated with PE. Women with EOPE had lower PlGF [median 0.73 MoM (IQR 0.63–0.83) vs. 1.22 (IQR 0.98–3.88) p = 0.02] and higher MAP [mean 104.3 (SD 15.0) mmHg vs. 95.4 (SD 11.5) mmHg p = 0.03] than women without EOPE. %hCG-h MoM was lower [median 0.76 (IQR 0.64–0.89) MoM vs. 1.02 (IQR 0.71–1.46) MoM p = 0.02] and MAP was higher [mean 101.0 (SD 14.5) mmHg vs. 95.0 (SD 11.2) mmHg p = 0.01] in the LOPE group than in those women that had not LOPE. The best multivariable models for PE, EOPE and LOPE are presented in Table 1. Download : Download high-res image (197KB) Download : Download full-size image Conclusions In univariate analyses low PlGF, high MAP and Uta PI were associated with pre-eclampsia. Women with EOPE had lower PlGF and higher MAP than women without EOPE and women with LOPE had lower %hCG-h and higher MAP than women without LOPE. In multivariable regression analyses the ROC values presented in this study did not meet requirements of a clinically useful screening test after validation.