Comparison of preeclampsia and fetal growth restriction screenings at first trimester in a high‐risk population

Infante, Ximena Carolina Romero; Uriel, Montserrat; Porras-Ramírez, Alexandra; Franco, Sara Rincón

doi:10.1111/jog.14605

Cited by 6 publications

(4 citation statements)

References 25 publications

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“…Nearly one quarter of maternal deaths in Latin America are associated with hypertensive disorders during pregnancy, and Colombia is one of the countries with the highest incidence of PE [ 13 ]. This is the most important reason for researching this topic in pregnant Colombian women and investigating which would be the most accurate screening test to counsel preventive treatment in those women who need it [ 4 , 5 , 7 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

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Higher PAPP-A Values in Pregnant Women Complicated with Preeclampsia Than with Gestational Hypertension

et al. 2023

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The purpose of this study is to compare the levels of maternal serum pregnancy–associated plasma protein-A at the first trimester in pregnancies complicated by impaired placental diseases, such as preeclampsia (PE), intrauterine fetal growth restriction (IUGR), and gestational hypertension (GH), with those in pregnancies without the development of any of these outcomes to expand the knowledge of how this protein behaves in the different impaired placental diseases. This current work is an observational study based on a prospective cohort. Pregnancy-associated plasma protein-A was measured in 422 patients who had completed maternal-perinatal outcomes. Comparisons of pregnancy characteristics and the biomarker between outcome groups (PE, IUGR, gestational hypertension, and not impaired placental outcomes) were analyzed. PAPP-A MoM in the IUGR (0.8 IQR: 0.6–0.9) and GH groups (0.5 IQR: 0.3–1.4) compared to the PE group (1.06 IQR: 0.66–1.52) was significantly lower (p < 0.005). Pregnant women who developed early-onset PE (1.11 IQR 1.08–1.18) presented significant differences with the IUGR group (0.83 IQR: 0.59–0.98; p = 0.002) and those who developed preterm-PE (1.19 IQR: 0.66–1.58; p = 0.045). The results demonstrate that the levels of PAPP-A at first trimester in the sample of women who developed PE, and specially term-PE, were higher than those in women who developed GH or IUGR. The GH group had the lowest PAPP-A values in this sample of pregnant women. Research in a population with a high prevalence of preeclampsia is still lacking and deserves more extended studies to define if these patients could have different rates of PAPP-A.

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Section: Discussionmentioning

confidence: 99%

“…These trials could determine that low-serum levels of PAPP-A were associated with a higher incidence of PE and IUGR. Since this discovery, PAPP-A biomarker is part of the model of early screening for PE and IUGR at first trimester of pregnancy that is used nowadays [ 7 – 9 , 18 , 20 – 23 ].…”

Section: Introductionmentioning

confidence: 99%

Higher PAPP-A Values in Pregnant Women Complicated with Preeclampsia Than with Gestational Hypertension

et al. 2023

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“…There is a balance to be struck between identifying pregnancies that are sufficiently severely affected to justify the possible risks of the intervention but not so severely affected that there is no potential to determine efficacy. Numerous studies have investigated predictive markers for the development of FGR (17)(18)(19)(20)(21)(22), but far fewer have studied the prediction of pregnancy outcome when early-onset FGR is diagnosed. Lack of knowledge about pregnancy outcome in FGR makes it difficult to optimise the inclusion criteria for clinical trials, but it also leaves pregnant patients and their partners with a considerable burden of uncertainty (23,24).…”

Section: Introductionmentioning

confidence: 99%

Ultrasound and biochemical predictors of pregnancy outcome at diagnosis of early-onset fetal growth restriction

Spencer

Maksym

Hecher

et al. 2023

Preprint

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Background: Severe early-onset fetal growth restriction (FGR) causes significant fetal and neonatal mortality and morbidity. Predicting the outcome of affected pregnancies at the time of diagnosis is difficult, preventing accurate patient counselling. We investigated the use of maternal serum protein and ultrasound measures at diagnosis to predict fetal or neonatal death and three secondary outcomes: fetal death or delivery ≤28+0 weeks; development of abnormal umbilical artery Doppler velocimetry; slow fetal growth. Methods: Women with singleton pregnancies (n=142, estimated fetal weights [EFWs] <3rd centile, <600g 20+0-26+6 weeks of gestation, no known chromosomal, genetic or major structural abnormalities), were recruited from four European centres. Maternal serum from the discovery set (n=63) was analysed for seven proteins linked to angiogenesis, 90 additional proteins associated with cardiovascular disease and five proteins identified through pooled liquid chromatography tandem mass spectrometry. Patient and clinician stakeholder priorities were used to select models tested in the validation set (n=60), with final models calculated from combined data. Results: The most discriminative model for fetal or neonatal death included EFW z-score (Hadlock 3 formula/Marsal chart), gestational age and umbilical artery Doppler category (AUC 0.91, 95%CI 0.86-0.97) but was less well calibrated than the model containing only EFW z-score (Hadlock3/Marsal). The most discriminative model for fetal death or delivery ≤28+0 weeks included maternal serum placental growth factor (PlGF) concentration and umbilical artery Doppler category (AUC 0.89, 95%CI 0.83-0.94). Conclusion: Ultrasound measurements and maternal serum PlGF concentration at diagnosis of severe early-onset FGR predict pregnancy outcomes of importance to patients and clinicians.

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“…There is a balance to be struck between identifying pregnancies that are sufficiently severely affected to justify the possible risks of the intervention but not so severely affected that there is no potential to determine efficacy. Numerous studies have investigated predictive markers for the development of FGR (17)(18)(19)(20)(21)(22), but far fewer have studied the prediction of pregnancy outcome when early-onset FGR is diagnosed. The inability to predict pregnancy outcomes leaves pregnant patients and their partners with a considerable burden of uncertainty (23,24).…”

Section: Introductionmentioning

confidence: 99%

Maternal PlGF and umbilical Dopplers predict pregnancy outcomes at diagnosis of early-onset fetal growth restriction

Spencer,

Maksym,

Hecher

et al. 2023

Journal of Clinical Investigation

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BACKGROUND. Severe, early-onset fetal growth restriction (FGR) causes significant fetal and neonatal mortality and morbidity. Predicting the outcome of affected pregnancies at the time of diagnosis is difficult, thus preventing accurate patient counseling. We investigated the use of maternal serum protein and ultrasound measurements at diagnosis to predict fetal or neonatal death and 3 secondary outcomes: fetal death or delivery at or before 28+0 weeks, development of abnormal umbilical artery (UmA) Doppler velocimetry, and slow fetal growth. METHODS.Women with singleton pregnancies (n = 142, estimated fetal weights [EFWs] below the third centile, less than 600 g, 20+0 to 26+6 weeks of gestation, no known chromosomal, genetic, or major structural abnormalities) were recruited from 4 European centers. Maternal serum from the discovery set (n = 63) was analyzed for 7 proteins linked to angiogenesis, 90 additional proteins associated with cardiovascular disease, and 5 proteins identified through pooled liquid chromatography and tandem mass spectrometry. Patient and clinician stakeholder priorities were used to select models tested in the validation set (n = 60), with final models calculated from combined data. RESULTS.The most discriminative model for fetal or neonatal death included the EFW z score (Hadlock 3 formula/Marsal chart), gestational age, and UmA Doppler category (AUC, 0.91; 95% CI, 0.86-0.97) but was less well calibrated than the model containing only the EFW z score (Hadlock 3/Marsal). The most discriminative model for fetal death or delivery at or before 28+0 weeks included maternal serum placental growth factor (PlGF) concentration and UmA Doppler category (AUC, 0.89; 95% CI, 0.83-0.94). CONCLUSION.Ultrasound measurements and maternal serum PlGF concentration at diagnosis of severe, early-onset FGR predicted pregnancy outcomes of importance to patients and clinicians. TRIAL REGISTRATION. ClinicalTrials.gov NCT02097667.

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Comparison of preeclampsia and fetal growth restriction screenings at first trimester in a high‐risk population

Cited by 6 publications

References 25 publications

Higher PAPP-A Values in Pregnant Women Complicated with Preeclampsia Than with Gestational Hypertension

Higher PAPP-A Values in Pregnant Women Complicated with Preeclampsia Than with Gestational Hypertension

Ultrasound and biochemical predictors of pregnancy outcome at diagnosis of early-onset fetal growth restriction

Maternal PlGF and umbilical Dopplers predict pregnancy outcomes at diagnosis of early-onset fetal growth restriction

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