Maternal Characteristics, Mean Arterial Pressure and Serum Markers in Early Prediction of Preeclampsia

OBJECTIVES In a previous study, we have described the predictive value of first-trimester Pregnancy-Associated Plasma Protein-A (PAPP-A), free β-subunit of human Chorionic Gonadotropin (fβ-hCG), Placental Growth Factor (PlGF) and A Disintegrin And Metalloprotease 12 (ADAM12) for early onset preeclampsia (EO-PE; delivery <34 weeks). The objective of the current study was to obtain the predictive value of these serum makers combined with maternal characteristics and first-trimester maternal mean arterial blood pressure (MAP) in a large series of patients, for both EO-PE and late onset PE (LO-PE; delivery ≥ 34 weeks). METHODS This was a nested case-control study, using stored first-trimester maternal serum from women who developed EO-PE (n = 68) or LO-PE (n = 99), and 500 uncomplicated singleton pregnancies. Maternal characteristics, MAP, and pregnancy outcome were collected for each individual woman and used to calculate prior risks for PE in a multiple logistic regression model. Models containing prior PE risks, serum markers, and MAP were developed for the prediction of EO-PE and LO-PE. The model-predicted detection rates (DR) for fixed 10% false-positive rates were calculated for EO-PE and LO-PE with or without the presence of a small-for-gestational age infant (SGA, birth weight <10(th) centile). RESULTS The best prediction model included maternal characteristics, MAP, PAPP-A, ADAM12, and PlGF, with DR of 72% for EO-PE and 49% for LO-PE. Prediction for PE with concomitant SGA was better than for PE alone (92% for EO-PE and 57% for LO-PE). CONCLUSION First-trimester MAP, PAPP-A, ADAM12, and PlGF combined with maternal characteristics and MAP are promising markers in the risk assessment of PE, especially for EO-PE complicated by SGA.