First-trimester placental protein 13, PAPP-A, uterine artery Doppler and maternal characteristics in the prediction of pre-eclampsia

• Published in: Placenta (Eastbourne) Vol. 32; no. 8; pp. 598 - 602
• Main Authors: Odibo, A.O, Zhong, Y, Goetzinger, K.R, Odibo, L, Bick, J.L, Bower, C.R, Nelson, D.M
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01-08-2011; Elsevier
• Subjects: Adult; Biological and medical sciences; Biomarkers - blood; Cohort Studies; Embryology: invertebrates and vertebrates. Teratology; Female; Fundamental and applied biological sciences. Psychology; Galectins - analysis; Humans; Internal Medicine; Obstetrics and Gynecology; PAPP-A; PP13; pre-eclampsia; Pre-Eclampsia - diagnosis; Prediction; Pregnancy; Pregnancy Proteins - analysis; Pregnancy Trimester, First; Pregnancy-Associated Plasma Protein-A - analysis; Prospective Studies; Sensitivity and Specificity; Ultrasonography, Doppler; Uterine artery; Uterine Artery - diagnostic imaging; Uterine Artery - physiology; PAPP-A; pre-eclampsia; Uterine artery; PP13; Prediction; Sonography; Doppler ultrasound study; Placental protein; Pregnancy disorders; Characteristic; First trimester; Pregnancy associated plasma protein A; Protein A; Pregnancy toxemia; Pregnancy; Vertebrata; Mammalia; Mother; Blood vessel; Preeclampsia; Circulatory system
• ISSN: 0143-4004; 1532-3102
• DOI: 10.1016/j.placenta.2011.05.006

Abstract Objective To test the hypothesis that a combination of PP13, PAPP-A and first-trimester uterine artery Doppler would improve the prediction of pre-eclampsia. Methods This is a prospective cohort study of pregnant women followed from the first-trimester to delivery. PP13 and PAPP-A were determined by immunoassay of maternal serum at 11–14 weeks’, when uterine artery Doppler measurements were assessed. Cases identified with any form of pre-eclampsia were compared with a control group without pre-eclampsia. The sensitivity of each marker or their combinations in predicting pre-eclampsia for different fixed false positive rates was calculated from the ROC curves. Results Forty two women were diagnosed with pre-eclampsia and 410 women with pregnancies not complicated by pre-eclampsia were used as controls. For a fixed false positive rate (FPR) of 20%, PP13, PAPP-A and mean uterine artery pulsatility index identified 49%, 58% and 62% respectively, of women who developed any form of pre-eclampsia. PP13 was best in predicting early onset pre-eclampsia with a sensitivity of 79% at a 20% FPR. Combinations of the three first-trimester assessments did not improve the prediction of pre-eclampsia in later pregnancy. Conclusion First-trimester PP13, PAPP-A and uterine artery PI are reasonable, individual predictors of women at risk to develop pre-eclampsia. Combinations of these assessments do not further improve the prediction of pre-eclampsia.