Diagnostic accuracy of the Gaussian first‐trimester combined screening for pre‐eclampsia to predict small‐for‐gestational‐age neonates

Abstract

Objective: Pre-eclampsia and delivery of small-for-gestational-age (SGA) neonates can be predicted from the first trimester. A Gaussian model for prediction of PE has recently been described, although its capacity to predict SGA is still unknown.Methods: This was a secondary analysis of a prospective cohort study conducted at Vall d'Hebron University Hospital (Barcelona) in 2483 single pregnancies from October 2015 to September 2017. Mean arterial blood pressure and mean uterine artery pulsatility index were recorded at the first-trimester scan. Serum concentrations of placental growth factor and pregnancy-associated plasma protein-A were assessed between 8 +0 and 13 +6 weeks. The predictive capacities of early (<32 weeks) and preterm (<37 weeks) SGA were tested. Results:For SGA without pre-eclampsia, detection rates of 25.0% (95% confidence interval [CI] 0-75.0) for early SGA and 14.3% (95% CI 3.6-28.6) for preterm SGA were achieved. For SGA with pre-eclampsia, the algorithm showed detection rates of 100.0% (95% CI 25.0-100.0) for early 3) for preterm SGA. Conclusion:This algorithm identifies 62.5% of early SGA and 27.3% of preterm SGA.Combined screening for predicting both pre-eclampsia and SGA by using the Gaussian algorithm is feasible and would simplify clinical practice.

First‐trimester screening for pre‐eclampsia and small for gestational age: A comparison of the gaussian and Fetal Medicine Foundation algorithms

“…plasma protein A [PAPP-A]) can predict PE and SGA. [1][2][3][4] The Fetal Medicine Foundation (FMF) and Gaussian algorithms can identify 80%-90% of pregnant women who will develop PE with delivery <32/<34 weeks of gestation 1,5 and 60%-70% of women who will develop PE with delivery <37 weeks, 1,6 at a 10% false-positive rate (FPR). These algorithms can also predict 50%-60% of SGA with delivery <32 weeks and 30%-40% of SGA with delivery <37 weeks.…”

“…Pre‐eclampsia (PE) and small for gestational age (SGA) are the main complications of placental disease. First‐trimester PE screening using algorithms that include a combination of maternal characteristics, biophysical markers (mean arterial blood pressure [MAP] and mean uterine artery pulsatility index [UtAPI]), and biochemical markers (placental growth factor [PlGF] and pregnancy‐associated plasma protein A [PAPP‐A]) can predict PE and SGA 1–4 . The Fetal Medicine Foundation (FMF) and Gaussian algorithms can identify 80%–90% of pregnant women who will develop PE with delivery <32/<34 weeks of gestation 1,5 and 60%–70% of women who will develop PE with delivery <37 weeks, 1,6 at a 10% false‐positive rate (FPR).…”

“…These algorithms can also predict 50%-60% of SGA with delivery <32 weeks and 30%-40% of SGA with delivery <37 weeks. 2,4 Both algorithms use a similar methodology to assess the risk for PE: they combine the a priori risk (based on maternal characteristics and obstetric and medical history) with the results of various biochemical and biophysical markers, to estimate the individual a posteriori risk for PE, which is used to classify a pregnant person as at high or low risk for PE. In both algorithms, risk for PE can be obtained based on maternal factors alone and in combination with any of the biochemical and/or biophysical markers.Despite the FMF algorithm being the most used and validated worldwide, the Gaussian algorithm has some features that confer advantages in the clinical setting, which is why it has been used for routine first-trimester PE screening in most maternities in Spain since 2018.…”

Implementation of routine first‐trimester combined screening for preeclampsia based on the Gaussian algorithm: A clinical effectiveness study

“…In this cohort study, participants of the study group were recruited from six maternity hospitals across Catalonia between November 2018 and May 2019 and participants of the reference group were prospectively recruited at Vall d'Hebron University Hospital (Barcelona, Spain) between October 2015 and September 2017 8,11 …”

Fetal growth restriction and stillbirth: Biomarkers for identifying at risk fetuses

“…These studies have not tracked longitudinal changes in function, and so FGR characterized by reduced growth velocity rather than Dephi consensus criteria (Kennedy et al, 2020;Molina et al, 2020) could have been miscategorized as a control pregnancy. Secondary applications of algorithms for predicting early-onset pre-eclampsia have been tested for their capacity to predict SGA at birth (Mendoza et al, 2022). Overall, they have an overall poor predictive value (Crovetto et al, 2017), preventing current use in screening a "low-risk" population (Blitz et al, 2016).…”