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

Abstract

Objective: Pre-eclampsia (PE) and small for gestational age (SGA) can be predicted from the first trimester. The most widely used algorithm worldwide is the Fetal Medicine Foundation (FMF) algorithm. The recently described Gaussian algorithm has reported excellent results although it is unlikely to be externally validated. Therefore, as an alternative approach, we compared the predictive accuracy for PE and SGA of the Gaussian and FMF algorithms.Methods: Secondary analysis of a prospective cohort study was conducted at Vall d'Hebron University Hospital (Barcelona) with 2641 singleton pregnancies. The areas under the curve for the predictive performance for early-onset and preterm PE and early-onset and preterm SGA were calculated with the Gaussian and FMF algorithms and subsequently compared. Results:The FMF and Gaussian algorithms showed a similar predictive performance for most outcomes and marker combinations. Nevertheless, significant differences for early-onset PE prediction favored the Gaussian algorithm in the following combinations: mean arterial blood pressure (MAP) with pregnancy-associated plasma protein A, MAP with placental growth factor, and MAP alone. Conclusions:The first-trimester Gaussian and FMF algorithms have similar performances for PE and SGA prediction when applied with all markers within a routine care setting in a Spanish population, adding evidence to the external validity of the FMF algorithm. K E Y W O R D S early-onset pre-eclampsia, first trimester, PlGF, pre-eclampsia, screening, uterine artery doppler 1 | INTRODUC TI ON 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 Berta Serrano and Erica Bonacina contributed equally to this article (co-first authors).| 151 SERRANO et al.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. 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 FM...

Reducing the Risk of Pre-Eclampsia in Women with Polycystic Ovary Syndrome Using a Combination of Pregnancy Screening, Lifestyle, and Medical Management Strategies

“…There is ongoing debate regarding which risk factors to include and the type of measures that should be part of risk assessment strategies [ 43 ]. Clinical practice guidelines (CPGs) recommend a combination of predictive assessments that include clinical risk factors, biophysical markers such as MAP and UtAPI, and biochemical markers such as pregnancy-associated plasma protein A (PAPP-A) and/or PlGF [ 44 , 45 ]. Various combinations of these measures are advised by different national bodies and professional societies [ 32 , 43 , 46 ].…”

Prevention of Pregnancy Complications Using a Multimodal Lifestyle, Screening, and Medical Model

“…First and second trimester screening strategies have been developed following rigorous preclinical, case control, observational, intervention, and real-world evaluation studies [9,10]. These screening models have been found to have good predictive value for early diagnosis of some obstetric syndromes, such as pre-eclampsia (PE) and fetal growth restriction (FGR), and result in increased surveillance of all women identified as high-risk [10,11]. Multivariate screening can be performed at 11-14 weeks gestation using a combination of maternal, biophysical, and serum biochemical markers [9].…”

Clinical effectiveness of routine first‐trimester combined screening for pre‐eclampsia in Spain with the addition of placental growth factor

“…The Gaussian algorithm was designed to predict early-onset PE; however, it has shown a similar performance to that of the Fetal Medicine Foundation algorithm for predicting preterm PE, early-onset PE and small for gestational age (SGA) fetuses in a Spanish population. 11 The ASPRE trial showed that daily administration of 150 mg of salicylic acid (ASA) before 16 weeks reduces the incidence of preterm PE by 62% and may also reduce the incidence of early-onset PE, early-onset SGA and preterm SGA by 82%, 40% and 20%, respectively. 12 These favorable findings were observed in a research context; however, a screening strategy may be less effective in real-life clinical practice.…”

“…Nevertheless, in most Spanish maternities the Gaussian algorithm is used for routine screening in the first trimester, as it allows assessment of the UtAPI by Doppler ultrasound either transabdominally or transvaginally, and measurement of the biomarkers between 8 +0 and 13 +6 weeks, 10 rendering it easy to integrate with the first‐trimester aneuploidy screening, and highly adaptable in different settings. The Gaussian algorithm was designed to predict early‐onset PE; however, it has shown a similar performance to that of the Fetal Medicine Foundation algorithm for predicting preterm PE, early‐onset PE and small for gestational age (SGA) fetuses in a Spanish population 11 …”

“…The Gaussian algorithm was designed to predict early‐onset PE; however, it has shown a similar performance to that of the Fetal Medicine Foundation algorithm for predicting preterm PE, early‐onset PE and small for gestational age (SGA) fetuses in a Spanish population. 11 …”