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Screening for pre-eclampsia by maternal factors and biomarkers at 11–13 weeks’ gestation
Open accessAbstract
OBJECTIVE: To examine the performance of screening for early, preterm and term pre-eclampsia (PE) at 11-13 weeks' gestation by maternal factors and combinations of mean arterial pressure (MAP), uterine artery (UtA) pulsatility index (PI), serum placental growth factor (PlGF) and serum pregnancy-associated plasma protein-A (PAPP-A). METHODS: The data for this study were derived from three previously reported prospective non-intervention screening studies at 11 + 0 to 13 + 6 weeks' gestation in a combined total of 61 174 singleton pregnancies, including 1770 (2.9%) that developed PE. Bayes' theorem was used to combine the prior distribution of gestational age at delivery with PE, obtained from maternal characteristics, with various combinations of biomarker multiples of the median (MoM) values to derive patient-specific risks of delivery with PE at < 37 weeks' gestation. The performance of such screening was estimated. RESULTS: In pregnancies that developed PE, compared to those without PE, the MoM values of UtA-PI and MAP were increased and those of PAPP-A and PlGF were decreased, and the deviation from normal was greater for early than late PE for all four biomarkers. Combined screening by maternal factors, UtA-PI, MAP and PlGF predicted 90% of early PE, 75% of preterm PE and 41% of term PE, at a screen-positive rate of 10%; inclusion of PAPP-A did not improve the performance of screening. The performance of screening depended on the racial origin of the women; on screening by a combination of maternal factors, MAP, UtA-PI and PlGF and using a risk cut-off of 1 in 100 for PE at < 37 weeks in Caucasian women, the screen-positive rate was 10% and detection rates for early, preterm and term PE were 88%, 69% and 40%, respectively. With the same method of screening and risk cut-off in women of Afro-Caribbean racial origin, the screen-positive rate was 34% and detection rates for early, preterm and term PE were 100%, 92% and 75%, respectively. CONCLUSION: Screening by maternal factors and biomarkers at 11-13 weeks' gestation can identify a high proportion of pregnancies that develop early and preterm PE. © 2018 Crown copyright. Ultrasound in Obstetrics & Gynecology © 2018 ISUOG.
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“while for women of Afro-Caribbean origin, the rates are 100%, 92% and 75%, respectively [71].”
From First-Trimester Ultrasound: A Comparative Review of Guidelines (2026) · cites this paper as [71]
In the citing paper
“More specifically, the combination of the above-mentioned, with the exception of PAPP-A, leads to the prediction of early, preterm and term preeclampsia in Caucasian women at rates of 88%, 69% and 40%, respectively”
From First-Trimester Ultrasound: A Comparative Review of Guidelines (2026) · cites this paper as [71]
In the citing paper
“More specifically, a combination of uterine arteries’ Doppler, mean arterial pressure (MAP) and PlGF resulted in a prediction of 90% for early, 75% for preterm and 41% for term preeclampsia [71].”
From First-Trimester Ultrasound: A Comparative Review of Guidelines (2026) · cites this paper as [71]
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Metadata
- Authors
- Tan, M. Y., Syngelaki, A., Poon, L. C., Rolnik, D. L., O'Gorman, N., Delgado, J. L., Akolekar, R., Konstantinidou, L., Tsavdaridou, M., Galeva, S., Ajdacka, U., Molina, F. S., Persico, N., Jani, J. C., Plasencia, W., Greco, E., Papaioannou, G., Wright, A., Wright, D., & Nicolaides, K. H.
- Affiliations
- King's College London (GB)
- King's College Hospital (GB)
- King's College Hospital London UK
- Hospital Clínico Universitario Virgen de la Arrixaca Murcia Spain
- Medway Maritime Hospital (GB)
- Homerton University Hospital (GB)
- North Middlesex Hospital (GB)
- University Hospital Lewisham (GB)
- Southend University Hospital NHS Foundation Trust (GB)
- Hospital Universitario San Cecilio Granada Spain
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT)
- Université Libre de Bruxelles (BE)
- Hospiten Group (ES)
- Royal London Hospital (GB)
- University General Hospital Attikon (GR)
- University of Exeter (GB)
- Corresponding author
- Nicolaides, K. H.
- ORCID
- Venue
- Ultrasound in Obstetrics & Gynecology
- Publisher
- Wiley
- Published
- 2018-07-11
- Volume
- 52
- Issue
- 2
- Pages
- 186-195
- ISSN
- 0960-7692 (ISSN-L)
- 1469-0705
- OpenAlex
- W2808436993
- Cited by
- 438
- References
- 31
- Citations by year
- 2026: 59 · 2025: 62 · 2024: 61 · 2023: 83 · 2022: 60 · 2021: 41 · 2020: 42 · 2019: 24 · 2018: 6
- FWCI
- 31.72
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- Locations
- Ultrasound in Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- RISalud Institutional Health Repository of Andalucía (submittedVersion, other-oa)
- Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) (submittedVersion)
- Queen Mary Research Online (Queen Mary University of London) (submittedVersion)
- Funders
- Fetal Medicine Foundation ((UK Charity No: 1037116))
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Screening and Diagnostics
- Health Sciences › Medicine › Clinical Neurology › Neurological Complications and Syndromes
- Keywords
- preeclampsia, preeclampsia screening, first-trimester screening, maternal risk factors, mean arterial pressure, uterine artery pulsatility index, placental growth factor, PAPP-A, Bayes' theorem, risk prediction, preterm preeclampsia, racial differences
- MeSH terms
- Placenta Growth Factor, Adult, Bayes Theorem, Female, Gestational Age, Humans, Pre-Eclampsia, Pregnancy, Pregnancy Trimester, First, Pregnancy-Associated Plasma Protein-A, Prospective Studies, Pulsatile Flow, Biomarkers, Risk Assessment, Vascular Endothelial Growth Factor Receptor-1, Uterine Artery, Arterial Pressure
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