Prediction of pre-eclampsia by uterine artery Doppler ultrasonography and maternal serum pregnancy-associated plasma protein-A, free β-human chorionic gonadotropin, activin A and inhibin A at 22+0 to 24+6 weeks' gestation

被引:83
作者
Spencer, K.
Yu, C. K. H.
Savvidou, M.
Papageorghiou, A. T.
Nicolaides, K. H.
机构
[1] Harold Wood Hosp, Dept Clin Biochem, Prenatal Screening Unit, Romford RM3 0BE, Essex, England
[2] Kings Coll Hosp London, Sch Med, Harris Birthright Res Ctr Fetal Med, London SE5 8RX, England
关键词
activin A; inhibin A; maternal serum biochemistry; pre-eclampsia; screening; uterine artery Doppler;
D O I
10.1002/uog.2676
中图分类号
O42 [声学];
学科分类号
070206 ; 082403 ;
摘要
Objective: To investigate the potential value of combining uterine artery Doppler ultrasonograpby with the measurement of maternal serum pregnancy-associated plasma protein-A (PAPP-A), free beta-human chorionic gonadotropin (beta-hCG), activin A and inhibin A at 22 + 0 to 24 + 6 weeks' gestation, in the Prediction of pregnancies that subsequently develop pre-eclampsia. Methods: The maternal serum PAPP-A, free beta-hCG, activin A and inhibin A concentrations at 22 + 0 to 24 + 6 weeks' gestation were measured in samples obtained from women with singleton pregnancies who participated in a screening stud), for pre-eclampsia by transvaginal color flow Doppler measurement of the uterine artery pulsatility index (PI). A search was made of the database to identify those who subsequently developed pre-eclampsia (n = 24) and a group of controls with normal outcome (n = 144). Regression analysis was performed to establish any relationship between the biochemical markers themselves and between the biochemical markers and uterine artery mean PI. A multivariate Gaussian model combining various biochemical markers with uterine artery mean PI was developed using standard statistical modeling techniques and the performance of such models in discriminating cases with pre-eclampsia was evaluated by receiver-operating characteristics curve (ROC) analysis. Results: In the pre-eclampsia group, compared to the controls, the uterine artery mean PI and the maternal serum levels of PAPP-A, free beta-hCG, activin A and inhibin A were significantly increased. The predicted detection rates of pre-eclampsia, for a false positive rate of 5%, was 50% by uterine artery mean PI, 5% by PAPP-A, 10% by free beta-hCG, 35% by inhibin A and 44% by activin A. Screening by a combination of uterine artery mean PI and maternal serum activin A and inhibin A could detect 75% and 92% of patients who subsequently developed pre-eclampsia, for false positive rates of 5% and 10%, respectively. Conclusion: Screening for pre-eclampsia by uterine artery PI at 22 + 0 to 24 + 6 weeks' gestation can be improved by measurement of activin A and inhibin A levels. Copyright (c) 2006 ISUOG. Published by John Wiley & Sons, Ltd.
引用
收藏
页码:658 / 663
页数:6
相关论文
共 48 条
[1]   Second-trimester maternal serum inhibin A concentration as an early marker for preeclampsia [J].
Aquilina, J ;
Barnett, A ;
Thompson, O ;
Harrington, K .
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 1999, 181 (01) :131-136
[2]   Improved early prediction of pre-eclampsia by combining second-trimester maternal serum inhibin-A and uterine artery Doppler [J].
Aquilina, J ;
Thompson, O ;
Thilaganathan, B ;
Harrington, K .
ULTRASOUND IN OBSTETRICS & GYNECOLOGY, 2001, 17 (06) :477-484
[3]   Women with preeclampsia have increased serum levels of pregnancy-associated plasma protein a (PAPP-A), inhibin A, activin A, and soluble E-selectin [J].
Bersinger, NA ;
Smárason, AK ;
Muttukrishna, S ;
Groome, NP ;
Redman, CW .
HYPERTENSION IN PREGNANCY, 2003, 22 (01) :45-55
[4]   Pregnancy-associated and placental proteins in the placental tissue of normal pregnant women and patients with pre-eclampsia at term [J].
Bersinger, NA ;
Groome, N ;
Muutukrishna, S .
EUROPEAN JOURNAL OF ENDOCRINOLOGY, 2002, 147 (06) :785-793
[5]   Metalloproteinase pregnancy-associated plasma protein A is a critical growth regulatory factor during fetal development [J].
Conover, CA ;
Bale, LK ;
Overgaard, MT ;
Johnstone, EW ;
Laursen, UH ;
Füchtbauer, EM ;
Oxvig, C ;
van Deursen, J .
DEVELOPMENT, 2004, 131 (05) :1187-1194
[6]  
CROSIGNANI PG, 1974, OBSTET GYNECOL, V44, P673
[7]   Maternal serum inhibin A can predict pre-eclampsia [J].
Cuckle, H ;
Sehmi, I ;
Jones, R .
BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY, 1998, 105 (10) :1101-1103
[8]   Increased maternal serum activin A but not follistatin levels in pregnant women with hypertensive disorders [J].
D'Antona, D ;
Reis, FM ;
Benedetto, C ;
Evans, LW ;
Groome, NP ;
de Kretser, DM ;
Wallace, EM ;
Petraglia, F .
JOURNAL OF ENDOCRINOLOGY, 2000, 165 (01) :157-162
[9]   THE CLASSIFICATION AND DEFINITION OF THE HYPERTENSIVE DISORDERS OF PREGNANCY [J].
DAVEY, DA ;
MACGILLIVRAY, I .
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 1988, 158 (04) :892-898
[10]   Maternal serum activin, inhibin, human chorionic gonadotrophin and α-fetoprotein as second trimester predictors of pre-eclampsia [J].
Davidson, EJ ;
Riley, SC ;
Roberts, SA ;
Shearing, CH ;
Groome, NP ;
Martin, CW .
BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, 2003, 110 (01) :46-52