BACKGROUND AND PURPOSE:

• Approaches for predicting preeclampsia risk include
  • Placental growth factor (PlGF) concentration measurements
  • Ratio of of soluble fms-like tyrosine kinase-1 and placental growth factor concentrations
  • Bayes’ theorem-based method, using various combinations of maternal characteristics, medical history and biomarker levels
• Ciobanu et al. (AJOG, 2019) compared the performance of various screening methods used to predict preeclampsia at within 2 weeks and within 4 weeks after a screening assessment that is done between 35w0d and 36w6d

METHODS:

• Multicentered prospective observational study
• Participants
  • Women attending a routine hospital visit between 35w0d and 36w6d
• Data obtained
  • Maternal demographic characteristics and medical history
  • Measurement of serum placental growth factor and soluble fms-like tyrosine kinase-1
  • Mean arterial pressure (MAP)
• Data analysis
  • Areas under the ROC curves were used to compare the predictive performance for the following
    • PlGF alone and the soluble fms-like tyrosine kinase-1/placental growth factor ratio
    • Triple test: Bayesian model that incorporates maternal factors and (1) PlGF; (2) Soluble fms-like tyrosine kinase-1; (3) MAP

RESULTS:

• 15,247 pregnancies | 326 (2.1%) with preeclampsia
• Performance of screening tests based on ROC curves to predict preeclampsia at ≤2 weeks following screening
  • Triple test: 0.975 (95% CI, 0.964–0.985)
  • PlGF alone: 0.900 (95% CI, 0.866–0.935) (Triple test significantly superior P<.0001)
  • Soluble fms-like tyrosine kinase-1/PlGF ratio: 0.932 (95% CI, 0.904–0.960; Triple test significantly superior P=.0001)
• Performance of screening tests based on ROC curves to predict preeclampsia at ≤4 weeks following screening
  • Triple test: 0.907 (95% CI, 0.886–0.928)
  • PlGF alone: 0.827 (95% CI, 0.800–0.854; Triple test significantly superior P<.0001)
  • Soluble fms-like tyrosine kinase-1/PlGF ratio: 0.857 (95% CI, 0.830–0.883; Triple test significantly superior P<.0001)
• Screen positive rates: The triple test’s screen-positive rates ranged from 2% to 30% depending on the cut-offs used and were
  • 10% higher than that of the soluble fms-like tyrosine kinase-1/placental growth factor ratio
  • 20% higher than that of placental growth factor alone
• Negative predictive values were similar across all 3 test approaches

CONCLUSION:

• The performance of the triple test to detect preeclampsia in the subsequent 2 and 4 week time frame was superior to PlGF alone or the soluble fms-like tyrosine kinase-1/PlGF ratio in screening for preeclampsia when screening was performed between 35w0d and 36w6d

Learn More – Primary Sources:

Prediction of imminent preeclampsia at 35–37 weeks gestation

Related ObG Topics:

ASPRE Trial: A Combined Risk Algorithm and Use of Aspirin to Prevent Preterm Preeclampsia

Results from the SPREE Trial: How Does First Trimester Preeclampsia Screening Compare to Current Guidelines?

Which Markers Can We Use to Screen for Early and Late Preeclampsia?