First‐trimester maternal factors and biomarker screening for preeclampsia

Abstract

Preeclampsia (PE), which affects about 2% of pregnancies, is a major cause of maternal and perinatal morbidity and mortality. PE can be subdivided into early onset PE with delivery <34 weeks' gestation and late onset PE with delivery ≥34 weeks. Early onset PE is associated with a higher incidence of adverse outcome. This review illustrates that effective screening for the development of early onset PE can be provided in the first-trimester of pregnancy. Screening by a combination of maternal risk factors, mean arterial pressure, uterine artery Doppler, maternal serum pregnancy-associated plasma protein-A and placental growth factor can identify about 95% of cases of early onset PE for a false-positive rate of 10%.

Clinical and Biochemical Markers for Prediction of Preeclampsia

“…Consequently, the measured concentrations of PAPP-A and PlGF must be adjusted for these variables before comparing results with pathological pregnancies. The MoM values of PAPP-A and PlGF are significantly reduced at 11-13 weeks' gestation in women who subsequently develop PE [3,18].…”

“…Maternal serum PAPP-A and PlGF are two biochemical markers that have been investigated extensively and have shown promising results in the early prediction of PE. They have both been shown to be useful inscreening for aneuploidies at 11-13 weeks' gestation [3]. In chromosomally normal pregnancies, there is evidence that low maternal serum PAPP-A in the first-and second-trimesters is associated with increased risk for subsequent development of PE.…”

“…In PE, defective invasion of the spiral arteries by cytotrophoblast cells is associated with inadequate uteroplacental blood flow [3,12,16]. Doppler ultrasonography might be used to assess the velocity of uterine blood flow and indirectly evaluate the trophoblastic invasion of the spiral arteries.…”

“…The impaired placental perfusion reflects in increaseduterine artery pulsatility index (PI). The ability to achieve a reliable measurement of uterine arteryPI is dependent on appropriate training of sonographers [3]. One of the most widely studied Doppler indices is the pulsatility index (calculated as the peak systolic flow minus specificity the end diastolic flow divided by the mean flow).…”

“…Major risk factors for PE are: nuliparity, maternal age >40, prior PE, anti phospholipid antibody syndrome, family history of pe in first-degree relative, renal disease, chronic hypertension, diabetes mellitus, multiple gestations, strong family history of cv disease (heart disease or stroke in ≥2 first-degree relatives), obesity etc [1,3,12]. The maternal demographic characteristics, including medical and obstetric history, are potentially useful in screening for PE, but only when the various factors are incorporated into a combined algorithm derived by multivariate analysis [3].Blood pressure measurement is a screening test routinely used in antenatal care to detect or predict a hypertensive disease. Studies investigating the predictive accuracy of blood pressure measurement report conflicting results.…”