Serum tumor necrosis factor-α level and uterine artery Doppler indices at 11–13 weeks’ gestation for preeclampsia screening in low-risk pregnancies: a prospective observational study

Abstract

Preeclampsia affects 1–2% of human pregnancies with no effective screening test. Studies have found some association between cytokines/other biomarkers and the later onset of preeclampsia. The challenge has been to find indicators with sufficient positive predictive value. A prospective observational study recruiting 500 low-risk pregnant women was carried out. Serum TNF-α and uterine artery Doppler were measured at 11–13 weeks. TNF-α cut-off value ≥14pg/mL had a sensitivity of 67.8% and a specificity of 98% in predicting PE with PPV of 79.4% and NPV of 96.4%. Mean uterine artery PI ≥1.7 had a 100% sensitivity and 84.4% specificity in predicting PE, with a PPV of 41.7% and NPV of 100%. When combining both parameters together we had 88.6% sensitivity and 100% specificity in predicting PE with a PPV of 100% and NPV of 98.6%. Serum TNF-α assay improves the performance of mean uterine artery PI at 11–13 weeks for PE screening and the combination of both tests can rule out PE in the case of normal results.