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

Skrastad, Ragnhild B.; Hov, Gunhild G.; Blaas, Harm-Gerd K.; Romundstad, Pal R. and Salvesen, Kjell LU (2014) In Acta Obstetricia et Gynecologica Scandinavica 93(12). p.1238-1247
Abstract
ObjectiveTo 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. DesignProspective screening study. SettingNational Center for Fetal Medicine, Trondheim, Norway. Population579 women who were nulliparous or had a previous history of preeclampsia or gestational hypertension. MethodsWomen were examined between 11(+0) and 13(+6)weeks, with interviews for maternal characteristics and measurements of MAP,... (More)
ObjectiveTo 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. DesignProspective screening study. SettingNational Center for Fetal Medicine, Trondheim, Norway. Population579 women who were nulliparous or had a previous history of preeclampsia or gestational hypertension. MethodsWomen 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 measuresPrediction of preeclampsia, severe preeclampsia and gestational hypertension. ResultsThe 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. ConclusionsMaternal 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. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Preeclampsia, screening, first trimester, ultrasound, Doppler, blood, pressure, biomarkers, uterine artery
in
Acta Obstetricia et Gynecologica Scandinavica
volume
93
issue
12
pages
1238 - 1247
publisher
Wiley-Blackwell
external identifiers
  • wos:000344876200004
  • scopus:84912052328
ISSN
1600-0412
DOI
10.1111/aogs.12479
language
English
LU publication?
yes
id
4ac8b627-bee7-4291-a1af-b34dd7ee5076 (old id 4982783)
date added to LUP
2015-02-03 07:10:24
date last changed
2017-01-01 06:28:55
@article{4ac8b627-bee7-4291-a1af-b34dd7ee5076,
  abstract     = {ObjectiveTo 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. DesignProspective screening study. SettingNational Center for Fetal Medicine, Trondheim, Norway. Population579 women who were nulliparous or had a previous history of preeclampsia or gestational hypertension. MethodsWomen 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 measuresPrediction of preeclampsia, severe preeclampsia and gestational hypertension. ResultsThe 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. ConclusionsMaternal 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.},
  author       = {Skrastad, Ragnhild B. and Hov, Gunhild G. and Blaas, Harm-Gerd K. and Romundstad, Pal R. and Salvesen, Kjell},
  issn         = {1600-0412},
  keyword      = {Preeclampsia,screening,first trimester,ultrasound,Doppler,blood,pressure,biomarkers,uterine artery},
  language     = {eng},
  number       = {12},
  pages        = {1238--1247},
  publisher    = {Wiley-Blackwell},
  series       = {Acta Obstetricia et Gynecologica Scandinavica},
  title        = {A prospective study of screening for hypertensive disorders of pregnancy at 11-13 weeks in a Scandinavian population},
  url          = {http://dx.doi.org/10.1111/aogs.12479},
  volume       = {93},
  year         = {2014},
}