First trimester aneuploidy screening program for preeclampsia prediction in a portuguese obstetric population.

Cláudia Teixeira,Eduardo Tejera,Irene Rebelo,António Tomé Pereira,Altamiro Costa-Pereira,Helena Martins

doi:10.1155/2014/435037

Abstract

Objective. To evaluate the performance of a first trimester aneuploidy screening program for preeclampsia (PE) prediction in a Portuguese obstetric population, when performed under routine clinical conditions. Materials and Methods. Retrospective cohort study of 5672 pregnant women who underwent routine first trimester aneuploidy screening in a Portuguese university hospital from January 2009 to June 2013. Logistic regression-based predictive models were developed for prediction of PE based on maternal characteristics, crown-rump length (CRL), nuchal translucency thickness (NT), and maternal serum levels of pregnancy-associated plasma protein-A (PAPP-A) and free beta-subunit of human chorionic gonadotropin (free β-hCG). Results. At a false-positive rate of 5/10%, the detection rate for early-onset (EO-PE) and late-onset (LO-PE) PE was 31.4/45.7% and 29.5/35.2%, respectively. Although both forms of PE were associated with decreased PAPP-A, logistic regression analysis revealed significant contributions from maternal factors, free β-hCG, CRL, and NT, but not PAPP-A, for prediction of PE. Conclusion. Our findings support that both clinical forms of EO-PE and LO-PE can be predicted using a combination of maternal history and biomarkers assessed at first trimester aneuploidy screening. However, detection rates were modest, suggesting that models need to be improved with additional markers not included in the current aneuploidy screening programs.

Highlights

Preeclampsia (PE) is a prevalent clinical entity in pregnancy, which is responsible for substantial maternal-fetal morbidity and mortality [1,2,3,4]
In both the EO-PE and LO-PE groups plasma protein-A (PAPP-A) were lower compared to unaffected pregnancies; there were no significant differences in free β-hCG, crown-rump length (CRL), and nuchal translucency thickness (NT)
Our study provides evidence that both clinical forms of EO-PE and LO-PE can be predicted using a combination of maternal history and biomarkers assessed at first trimester aneuploidy screening, in agreement with previous publications [9,10,11,12,13,14,15]

Summary

Introduction

Preeclampsia (PE) is a prevalent clinical entity in pregnancy, which is responsible for substantial maternal-fetal morbidity and mortality [1,2,3,4]. Screening for PE based only on maternal history has shown to be insufficient [6]. In this context, measurement in early pregnancy of a variety of markers implicated in the pathophysiology of PE has been proposed to predict its development. Measurement in early pregnancy of a variety of markers implicated in the pathophysiology of PE has been proposed to predict its development These included tests for aneuploidy screening, renal and endothelial dysfunction, oxidative stress, and fetal-derived products [7]. Because any single biomarker is unlikely to be effective in prediction of the onset of a disorder as heterogeneous as PE, it is under investigation which combinations of tests, such as ultrasound and serum markers, would raise the effectiveness of history and physical-based screening [7]

Methods

Results

Conclusion