Prediction of early, intermediate and late pre-eclampsia from maternal factors, biophysical and biochemical markers at 11-13 weeks.

OBJECTIVE To develop models for prediction of pre-eclampsia (PE) based on maternal factors and biophysical and biochemical markers at 11-13 weeks' gestation. METHODS Screening study of singleton pregnancies at 11-13 weeks including 752 (2.2%) that subsequently developed PE and 32,850 that were unaffected by PE. Models were developed for the prediction of early PE, requiring delivery before 34 weeks, intermediate PE with delivery at 34-37 weeks and late PE delivering after 37 weeks. The data used for the models were firstly, maternal characteristics and history, uterine artery pulsatility index, mean arterial pressure and serum pregnancy-associated plasma protein-A obtained from the screening study and secondly, maternal serum or plasma concentration of placental growth factor, placental protein-13, inhibin-A, activin-A, soluble endoglin, pentraxin-3 and P-selectin obtained from case-control studies. RESULTS In screening for PE by maternal factors only at a fixed false positive rate of 5%, the estimated detection rates were 33.0% for early PE, 27.8% for intermediate PE and 24.5% for late PE. The respective detection rates in screening by a combination of maternal factors, biophysical and biochemical markers were 91.0, 79.4 and 60.9%. CONCLUSIONS Effective prediction of PE can be achieved at 11-13 weeks' gestation.