OP14.03: Longitudinal study of maternal insulin-like growth factor-I and uterine artery Doppler

Abstract

Objective: To evaluate the performance of screening for preeclampsia (PET) in women who had both first and second trimester uterine artery (UtA) Doppler. Methods: This longitudinal study involved 3090 asymptomatic pregnant women who had UtA pulsatility index (PI) routinely at 11–14 and 20–25 weeks gestation. Demographic characteristics was also recorded contemporary. Multiple regression analysis was used to evaluate which of the maternal variables and Doppler findings were significant predictors of early-onset PET. Receiveroperating characteristics curves were used to evaluate the value as screening of different combined predictive models. Results: There were 93 (3.0%) women who later developed PET, including 30 women who delivered before 34 weeks gestation (early PET). Early and late PET differed substantially in their UtA PI findings during the first and second trimester of pregnancy. Multiple regression analysis showed that increased body mass index, previous PET, UtA PI at 11–14 and 20–25 weeks gestation, and the change in UtA resistance between the first and second trimester were significantly associated with the appearance of early PET. The detection rate of early PET for a 10% false positive rate in screening by maternal characteristics and first trimester UtA PI only and by a combination with a ratio between both UtA Dopplers was 50% and 82%, respectively. However, second trimester UtA PI alone was able to detect about 90% of women who subsequently developed early cases. Conclusion: This study has confirmed that the severe the PET the lower the magnitude of change in uterine artery dilatation between the first and second trimester of pregnancy. In addition, although the best methods to predict early PET is still the second trimester uterine artery Doppler, a combination between maternal findings, UtA Doppler at 11–14 weeks gestation and the ratio of changes between both trimesters should be also a good screening test for early PET. Supported by Fondecyt No 1090245