PMID- 30738886
OWN - NLM
STAT- Publisher
LR  - 20190330
IS  - 1097-6868 (Electronic)
IS  - 0002-9378 (Linking)
DP  - 2019 Feb 7
TI  - Prediction of imminent preeclampsia at 35-37 weeks gestation.
LID - S0002-9378(19)30289-3 [pii]
LID - 10.1016/j.ajog.2019.01.235 [doi]
AB  - BACKGROUND: In the weeks preceding the clinical onset of preeclampsia, the
      maternal serum level of the angiogenic placental growth factor is decreased and
      that of the antiangiogenic factor soluble fms-like tyrosine kinase-1 is
      increased. Women presenting at specialist clinics with signs or symptoms of
      hypertensive disorders have been stratified according to concentrations of
      placental growth factor or the ratio of concentrations of soluble fms-like
      tyrosine kinase-1 and placental growth factor to determine clinical management
      for the subsequent 1-4 weeks. An alternative approach for the prediction of
      preeclampsia is use of the competing risks model, a Bayes' theorem based method, 
      to derive patient-specific risk for preeclampsia by various combinations of
      maternal characteristics and medical history with multiples of the median values 
      of biomarkers. OBJECTIVE: The purpose of this study was to compare the
      performance of screening for delivery with preeclampsia at </=2 and </=4 weeks
      after assessment at 35(+0)-36(+6) weeks gestation between the use of percentile
      cut-offs in placental growth factor alone or the soluble fms-like tyrosine
      kinase-1/placental growth factor ratio and the competing risks model. STUDY
      DESIGN: This was a prospective observational study in women who attended a
      routine hospital visit at 35(+0)-36(+6) weeks gestation in 2 maternity hospitals 
      in England. The visits included the recording of maternal demographic
      characteristics and medical history and the measurement of serum placental growth
      factor and soluble fms-like tyrosine kinase-1 and mean arterial pressure. The
      areas under the receiver operating characteristics curves were used to compare
      the predictive performance for preeclampsia with delivery at </=2 and </=4 weeks 
      from assessment of screening by placental growth factor alone and the soluble
      fms-like tyrosine kinase-1/placental growth factor ratio with that of a
      previously developed competing risks model with a combination of maternal
      factors, placental growth factor, soluble fms-like tyrosine kinase-1, and mean
      arterial pressure (triple test). RESULTS: First, the study population of 15,247
      pregnancies included 326 pregnancies (2.1%) that subsequently experienced
      preeclampsia. Second, in the screening for delivery with preeclampsia at </=2 and
      </=4 weeks from assessment, the performance of the triple test was superior to
      that of placental growth factor alone or the soluble fms-like tyrosine
      kinase-1/placental growth factor ratio. The area under the receiver operating
      characteristics curves for preeclampsia at </=2 weeks in screening by the triple 
      test (0.975; 95% confidence interval, 0.964-0.985) was higher than that of
      placental growth factor alone (0.900; 95% confidence interval, 0.866-0.935;
      P<.0001) and the soluble fms-like tyrosine kinase-1/placental growth factor ratio
      (0.932; 95% confidence interval, 0.904-0.960; P=.0001). Similarly, the areas
      under the receiver operating characteristics curves for preeclampsia at </=4
      weeks in screening by the triple test (0.907; 95% confidence interval,
      0.886-0.928) was higher than that of placental growth factor alone (0.827; 95%
      confidence interval, 0.800-0.854; P<.0001) or the soluble fms-like tyrosine
      kinase-1/placental growth factor ratio (0.857; 95% confidence interval,
      0.830-0.883; P<.0001). Third, at most, screen-positive rates of 2-30% the
      detection rate of delivery with preeclampsia at </=2 and </=4 weeks that was
      achieved by the triple test was approximately 10% higher than that of the soluble
      fms-like tyrosine kinase-1/placental growth factor ratio and 20% higher than that
      of placental growth factor alone; the negative predictive value was similar for
      the 3 tests. CONCLUSION: At 35(+0)-36(+6) weeks gestation, the performance of
      screening for imminent delivery with preeclampsia by the competing risks model is
      superior to that of placental growth factor alone or the soluble fms-like
      tyrosine kinase-1/placental growth factor ratio.
CI  - Copyright (c) 2019 Elsevier Inc. All rights reserved.
FAU - Ciobanu, Anca
AU  - Ciobanu A
AD  - Harris Birthright Research Centre for Fetal Medicine, King's College, London, UK.
FAU - Wright, Alan
AU  - Wright A
AD  - Institute of Health Research, University of Exeter, Exeter, UK.
FAU - Panaitescu, Anca
AU  - Panaitescu A
AD  - Harris Birthright Research Centre for Fetal Medicine, King's College, London, UK.
FAU - Syngelaki, Argyro
AU  - Syngelaki A
AD  - Harris Birthright Research Centre for Fetal Medicine, King's College, London, UK.
FAU - Wright, David
AU  - Wright D
AD  - Institute of Health Research, University of Exeter, Exeter, UK.
FAU - Nicolaides, Kypros H
AU  - Nicolaides KH
AD  - Harris Birthright Research Centre for Fetal Medicine, King's College, London, UK.
      Electronic address: kypros@fetalmedicine.com.
LA  - eng
PT  - Journal Article
DEP - 20190207
PL  - United States
TA  - Am J Obstet Gynecol
JT  - American journal of obstetrics and gynecology
JID - 0370476
OTO - NOTNLM
OT  - biomarker
OT  - competing risks model
OT  - mean arterial pressure
OT  - placental growth factor
OT  - preeclampsia
OT  - screening
OT  - soluble fms-like tyrosine kinase-1
OT  - third trimester
EDAT- 2019/02/11 06:00
MHDA- 2019/02/11 06:00
CRDT- 2019/02/11 06:00
PHST- 2018/12/22 00:00 [received]
PHST- 2019/01/22 00:00 [revised]
PHST- 2019/01/30 00:00 [accepted]
PHST- 2019/02/11 06:00 [pubmed]
PHST- 2019/02/11 06:00 [medline]
PHST- 2019/02/11 06:00 [entrez]
AID - S0002-9378(19)30289-3 [pii]
AID - 10.1016/j.ajog.2019.01.235 [doi]
PST - aheadofprint
SO  - Am J Obstet Gynecol. 2019 Feb 7. pii: S0002-9378(19)30289-3. doi:
      10.1016/j.ajog.2019.01.235.