First-Trimester Preterm Preeclampsia Screening in Nulliparous Women: The Great Obstetrical Syndrome (GOS) Study

被引:14
作者
Boutin, Amelie [1 ]
Gasse, Cedric [1 ,2 ]
Guerby, Paul [1 ,3 ]
Giguere, Yves [1 ,4 ]
Tetu, Amelie [1 ]
Bujold, Emmanuel [1 ,3 ]
机构
[1] CHU Quebec Univ Laval Res Ctr, Reprod Mother & Child Hlth Unit, Quebec City, PQ, Canada
[2] Univ Laval, Dept Social & Prevent Med, Quebec City, PQ, Canada
[3] Univ Laval, Dept Obstet Gynecol & Reprod, Quebec City, PQ, Canada
[4] Univ Laval, Dept Mol Biol Med Biochem & Pathol, Quebec City, PQ, Canada
关键词
pre-eclampsia; screening; nulliparity; LOW-DOSE ASPIRIN; MATERNAL CHARACTERISTICS; TERM PREECLAMPSIA; PAPP-A; PREVENTION; PREDICTION; RISK; PREGNANCY;
D O I
10.1016/j.jogc.2020.06.011
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
Objectives: To estimate the ability of a combination of first-trimester markers to predict preterm preeclampsia in nulliparous women. Methods: We conducted a prospective cohort study of nulliparous women with singleton gestations, recruited between 11(0) and 13(6) weeks gestation. Data on the following were collected: maternal age; ethnicity; chronic diseases; use of fertility treatment; body mass index; mean arterial blood pressure (MAP); serum levels of pregnancy-associated plasma protein A (PAPP-A), placental growth factor (PlGF), soluble fms-like tyrosine kinase-1 (sFlt-1), alpha fetoprotein (AFP), free beta human chorionic gonadotropin (beta-hCG); and mean uterine artery pulsatility index (UtA-PI). We constructed a proportional hazard model for the prediction of preterm preeclampsia selected based on the Akaike information criterion. A receiver operating characteristic curve was created with the predicted risk from the final model. Our primary outcome was preterm preeclampsia and our secondary outcome was a composite of preeclampsia, small for gestational age, intrauterine death, and preterm birth. Results: Among 4659 nulliparous women with singleton gestations, our final model included 4 variables: MAP MoM, log(10)PlGF MoM, log(10)AFP MoM and log(10)UtA-PI MoM. We obtained an area under the curve of 0.84 (95% CI 0.75-0.93) with a detection rate of preterm preeclampsia of 55% (95% CI 37%-73%) and a false-positive rate of 10%. Using a risk cut-off with a false-positive rate of 10%, the positive predictive value for our composite outcome was 33% (95% CI 29%-37%). Conclusions: The combination of MAP, maternal serum PlGF and AFP, and UtA-PI are useful to identify nulliparous women at high risk of preterm preeclampsia but also at high risk of other great obstetrical syndromes.
引用
收藏
页码:43 / 49
页数:7
相关论文
共 30 条
[1]   Screening for preeclampsia using first-trimester serum markers and uterine artery Doppler in nulliparous women [J].
Audibert, Francois ;
Boucoiran, Isabelle ;
An, Na ;
Aleksandrov, Nikolai ;
Delvin, Edgard ;
Bujold, Emmanuel ;
Rey, Evelyne .
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 2010, 203 (04) :383.e1-383.e8
[2]   First-Trimester Placental Growth Factor for the Prediction of Preeclampsia in Nulliparous Women: The Great Obstetrical Syndromes Cohort Study [J].
Boutin, Amelie ;
Demers, Suzanne ;
Gasse, Cedric ;
Giguere, Yves ;
Tetu, Amelie ;
Laforest, Genevieve ;
Bujold, Emmanuel .
FETAL DIAGNOSIS AND THERAPY, 2019, 45 (02) :69-75
[3]   Does Low PAPP-A Predict Adverse Placenta-Mediated Outcomes in a Low-Risk Nulliparous Population? the Great Obstetrical Syndromes (GOS) Study [J].
Boutin, Amelie ;
Gasse, Cedric ;
Demers, Suzanne ;
Blanchet, Genevieve ;
Giguere, Yves ;
Bujold, Emmanuel .
JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA, 2018, 40 (06) :663-668
[4]   Maternal Characteristics for the Prediction of Preeclampsia in Nulliparous Women: The Great Obstetrical Syndromes (GOS) Study [J].
Boutin, Amelie ;
Gasse, Cedric ;
Demers, Suzanne ;
Giguere, Yves ;
Tetu, Amelie ;
Bujold, Emmanuel .
JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA, 2018, 40 (05) :572-578
[5]   Maternal serum alpha-fetoprotein at 12, 22 and 32 weeks' gestation in screening for pre-eclampsia [J].
Bredaki, F. E. ;
Mataliotakis, M. ;
Wright, A. ;
Wright, D. ;
Nicolaides, K. H. .
ULTRASOUND IN OBSTETRICS & GYNECOLOGY, 2016, 47 (04) :466-471
[6]   Prevention of Preeclampsia and Intrauterine Growth Restriction With Aspirin Started in Early Pregnancy A Meta-Analysis [J].
Bujold, Emmanuel ;
Roberge, Stephanie ;
Lacasse, Yves ;
Bureau, Marc ;
Audibert, Francois ;
Marcoux, Sylvie ;
Forest, Jean-Claude ;
Giguere, Yves .
OBSTETRICS AND GYNECOLOGY, 2010, 116 (02) :402-414
[7]   Does low-dose aspirin initiated before 11 weeks' gestation reduce the rate of preeclampsia? [J].
Chaemsaithong, Piya ;
Cuenca-Gomez, Diana ;
Plana, Maria N. ;
Gil, Maria M. ;
Poon, Liona C. .
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 2020, 222 (05) :437-450
[8]   Prediction models for preeclampsia: A systematic review [J].
De Kat, Annelien C. ;
Hirst, Jane ;
Woodward, Mark ;
Kennedy, Stephen ;
Peters, Sanne A. .
PREGNANCY HYPERTENSION-AN INTERNATIONAL JOURNAL OF WOMENS CARDIOVASCULAR HEALTH, 2019, 16 :48-66
[9]   Antiplatelet agents for preventing pre-eclampsia and its complications [J].
Duley, Lelia ;
Meher, Shireen ;
Hunter, Kylie E. ;
Seidler, Anna Lene ;
Askie, Lisa M. .
COCHRANE DATABASE OF SYSTEMATIC REVIEWS, 2019, (10)
[10]   Body mass index and the risk of hypertensive disorders of pregnancy: the great obstetrical syndromes (GOS) study [J].
Gasse, Cedric ;
Boutin, Amelie ;
Demers, Suzanne ;
Chaillet, Nils ;
Bujold, Emmanuel .
JOURNAL OF MATERNAL-FETAL & NEONATAL MEDICINE, 2019, 32 (07) :1063-1068