Ultrasound features prior to 11 weeks' gestation and first‐trimester maternal factors in prediction of hypertensive disorders of pregnancy

Abstract

CONTRIBUTIONWhat are the novel findings of this work? Trophoblast volume (TV) measured prior to 11 weeks' gestation is decreased significantly in pregnancy that subsequently develops maternal hypertension. What are the clinical implications of this work?The inclusion of TV in predictive algorithms for maternal hypertensive disorders has the potential to improve the value of current models used in clinical practice and to improve fetal and maternal outcomes. ABSTRACTObjectives Maternal hypertensive disorders (MHD), including pregnancy-induced hypertension and preeclampsia, are estimated to occur in 7-10% of pregnancies worldwide and have significant short-and long-term implications for both mother and fetus. This study aimed to determine the association of conventional and novel early first-trimester ultrasound measures with MHD and whether these ultrasound measures, combined with maternal characteristics and biochemistry, improve the prediction of MHD. MethodsThis was a prospective cohort study of consecutive women with a singleton pregnancy, attending for an early (5 + 1 to 11 + 0 weeks' gestation) ultrasound examination at a private obstetric ultrasound practice between February 2016 and August 2018. Recorded ultrasound measurements included mean sac diameter, yolk sac diameter, crown-rump length, fetal heart rate (FHR), trophoblast thickness, trophoblast volume (TV) and meanCorrespondence to: Ms T. J. Hanchard, South Coast Ultrasound for Women, uterine artery pulsatility index. Maternal biochemistry was assessed at 10-14 weeks and included beta-human chorionic gonadotropin, pregnancy-associated plasma protein-A (PAPP-A), placental growth factor (PlGF) and maternal serum alpha-fetoprotein. Regression models were fitted for each ultrasound parameter and multiples of the median (MoM) were calculated. All measures were compared between women who had a normotensive outcome and those who subsequently developed MHD. Logistic regression analysis was used to create a prediction model for MHD based on maternal characteristics, ultrasound measurements at 5 + 1 to 11 + 0 weeks' gestation and maternal biochemistry at 10-14 weeks. ResultsIn total, 1141 women were included in the analysis, of whom 1086 (95.2%) were normotensive at delivery and 55 (4.8%) developed MHD. Women who developed MHD weighed significantly more than did normotensive women (P < 0.0001). Mean MoM values for TV (P = 0.006), PAPP-A (P = 0.031) and PlGF (P = 0.044) were decreased significantly in pregnancies that subsequently developed MHD. The proposed logistic regression model includes maternal weight and height and MoM values for TV, FHR and PlGF, resulting in an area under the receiver-operating-characteristics curve of 0.80 (95% CI, 0.75-0.86). ConclusionThe combination of maternal weight and height, TV and FHR, measured prior to 11 weeks' gestation, and first-trimester PlGF appears to have good predictive value for development of MHD later in pregnancy.

Combining early (<11 weeks’ gestation) ultrasound features and maternal factors to predict small‐for‐gestational age neonates

“…Despite these entities both being considered primarily of placental origin, with many predictor variables in common, previous first trimester prediction models have not performed the same for each 14,39,40 and therefore they should be investigated separately. This is consistent with our results showing that the significant predictors in our model for SGA (maternal height, TV and PIGF) differ to our previously published results for the prediction of MHD (maternal height and weight, TV, PAPP‐A and PIGF) 16 …”

“…This was a prospective cohort study designed to assess the value of early ultrasound measurements in the prediction of maternal hypertensive disorders (MHD) and SGA. Analyses of these pregnancy outcomes were conducted separately with the results for the prediction of MHD previously published by the authors 16 . Consecutive patients that attended for an early (<11 weeks) ultrasound scan at a private obstetric ultrasound practice were enrolled in the study between February 2016 and August 2018.…”

“…After clotting, serum was aspirated and stored frozen (−18°C) until required for assay. Biochemical markers, free‐beta subunit of human chorionic gonadotropin (FBhCG), PAPP‐A, alpha fetoprotein (AFP) and PlGF, were quantified on DELFIA® Xpress random access immunoanalyzer (Wallac Oy, PerkinElmer) 16 …”

First‐trimester maternal haemodynamic adaptation to pregnancy and placental, embryonic and fetal development: the prospective observational Rotterdam Periconception cohort

“…This suggests that placental tissue and vasculature development are impacted differently and that the impact of first‐trimester haemodynamic (mal)adaptation seems more profound in placenta‐related complicated pregnancies 46 . Previous studies also describe reduced PV in pregnancies complicated by pre‐eclampsia or FGR 48,49 …”

“… 46 Previous studies also describe reduced PV in pregnancies complicated by pre‐eclampsia or FGR. 48 , 49 …”