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#Grand Rounds

Predicting Preeclampsia After 36 weeks Gestation

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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

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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?

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