A prospective study of screening for hypertensive disorders of pregnancy at 11-13 weeks in a Scandinavian population

Acta Obstet Gynecol Scand. 2014 Dec;93(12):1238-47. doi: 10.1111/aogs.12479. Epub 2014 Sep 17.

Abstract

Objective: To investigate the prediction of preeclampsia and gestational hypertension using maternal characteristics, mean arterial pressure (MAP), uterine artery pulsatility index (UtAPI), pregnancy-associated plasma protein-A (PAPP-A) and placental growth factor (PlGF) at gestational weeks 11-13 in a Scandinavian population with a medium to high prior risk for developing hypertensive disorders of pregnancy.

Design: Prospective screening study.

Setting: National Center for Fetal Medicine, Trondheim, Norway.

Population: 579 women who were nulliparous or had a previous history of preeclampsia or gestational hypertension.

Methods: Women were examined between 11(+0) and 13(+6) weeks, with interviews for maternal characteristics and measurements of MAP, UtAPI, PAPP-A and PlGF. The tests were evaluated separately and in combined models with receiver operating characteristics (ROC) curves.

Main outcome measures: Prediction of preeclampsia, severe preeclampsia and gestational hypertension.

Results: The best model for severe preeclampsia (MAP+UtAPI+PlGF+PAPP-A) achieved an area under the ROC curve of 0.866 [95% confidence interval (95% CI) 0.756-0.976]. The best models for preeclampsia (MAP+UtAPI+age) achieved 0.738 (0.634-0.841), gestational hypertension (MAP) 0.820 (0.727-0.913) and hypertensive disorders in pregnancy overall (MAP+PlGF+age) 0.783 (0.709-0.856). Using the best model we could identify 61.5% (95% CI 31.6-86.1) of severe preeclampsia, 38.5% (95% CI 20.2-59.4) of preeclampsia and 42.9% (95% CI 21.8-66) of gestational hypertension at a fixed 10% false-positive rate.

Conclusions: Maternal characteristics, MAP, UtAPI, PAPP-A and PlGF showed limited value as screening tests. Further research on biochemical and biophysical tests and algorithms combining these parameters is needed before first trimester screening for hypertensive disorders of pregnancy is included in antenatal care in Scandinavia.

Keywords: Doppler; Preeclampsia; biomarkers; blood pressure; first trimester; screening; ultrasound; uterine artery.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Blood Pressure / physiology
  • Confidence Intervals
  • Female
  • Humans
  • Norway / epidemiology
  • Odds Ratio
  • Placenta Growth Factor
  • Pre-Eclampsia / blood
  • Pre-Eclampsia / diagnosis*
  • Pregnancy
  • Pregnancy Proteins / blood*
  • Pregnancy Trimester, First / physiology
  • Pregnancy-Associated Plasma Protein-A / analysis*
  • Prenatal Care / methods
  • Prenatal Diagnosis / methods*
  • Prospective Studies
  • Pulsatile Flow
  • Risk Assessment / methods
  • Ultrasonography
  • Uterine Artery / diagnostic imaging*
  • Young Adult

Substances

  • PGF protein, human
  • Pregnancy Proteins
  • Placenta Growth Factor
  • Pregnancy-Associated Plasma Protein-A