Early Pregnancy Prediction of Preeclampsia in Nulliparous Women, Combining Clinical Risk and Biomarkers

Hypertension - Tập 64 Số 3 - Trang 644-652 - 2014
Louise C. Kenny1,2,3,4,5,6,7,8,9, Michael A. Black1,2,3,4,5,6,10,8,9, Lucilla Poston1,2,3,4,5,6,11,8,9, Rennae S. Taylor1,2,3,4,5,6,12,8,9, Jenny Myers1,2,3,4,5,6,13,8,9, Philip N. Baker1,2,3,14,4,5,6,8,9, Lesley McCowan1,2,3,14,4,5,6,8,9, Nigel Simpson1,2,3,14,4,5,6,8,9, Gus Dekker1,2,3,4,5,6,15,8,9, Claire T. Roberts1,2,16,3,4,5,6,8,9, Kelline Rodems1,2,3,4,5,6,17,8,9, B.W. Noland1,2,18,3,4,5,6,8,9, Michael Raymundo1,2,3,4,5,6,19,8,9, James J. Walker1,2,3,4,5,6,20,8,9, Robyn A. North1,2,3,14,4,5,6,8,9
1Alere Discovery, San Diego, CA (K.R., B.N., M.R.).
2Auckland District Health Board and Counties Manukau District Health Board, Auckland, New Zealand (P.N.B.)
3Department of Biochemistry, Otago School of Medical Sciences, University of Otago, Dunedin, New Zealand (M.A.B.)
4Division of Women's Health, Women's Health Academic Centre, King's College London and King's Health Partners, London, United Kingdom (L.P., R.A.N.)
5Faculty of Medical and Human Sciences, Maternal & Fetal Health Research Centre, Institute of Human Development, Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, University of Manchester, Manchester, United Kingdom (J.E.M.)
6From the Irish Centre for Fetal and Neonatal Translational Research (INFANT) and Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland (L.C.K.); Department of Biochemistry, Otago School of Medical Sciences, University of Otago, Dunedin, New Zealand (M.A.B.); Division of Women’s Health, Women’s Health Academic Centre, King’s College London and King’s Health Partners, London, United Kingdom (L.P., R.A.N.); Department of Obstetrics and Gynaecology, Faculty of Medical and...
7Louise C. Kenny From the Irish Centre for Fetal and Neonatal Translational Research (INFANT) and Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland (L.C.K.)
8Section of Obstetrics and Gynaecology, Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, United Kingdom (N.A.B.S., J.J.W.)
9The Women's and Children's Division, Lyell McEwin Hospital (G.A.D., C.T.R.) and School of Paediatrics and Reproductive Health, Robinson Institute (G.A.D., C.T.R.), University of Adelaide, Adelaide, South Australia
10Michael A. Black From the Irish Centre for Fetal and Neonatal Translational Research (INFANT) and Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland (L.C.K.)
11Lucilla Poston From the Irish Centre for Fetal and Neonatal Translational Research (INFANT) and Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland (L.C.K.)
12Rennae Taylor From the Irish Centre for Fetal and Neonatal Translational Research (INFANT) and Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland (L.C.K.)
13Jenny E. Myers From the Irish Centre for Fetal and Neonatal Translational Research (INFANT) and Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland (L.C.K.)
14Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences (R.T., P.N.B., L.M.M.), National Centre for Growth and Development and Maternal and Fetal Health, Liggins Institute (P.N.B.), and South Auckland Clinical School, Faculty of Medical and Health Sciences (L.M.M.), University of Auckland, Auckland, New Zealand
15Gus A. Dekker From the Irish Centre for Fetal and Neonatal Translational Research (INFANT) and Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland (L.C.K.)
16Claire T. Roberts From the Irish Centre for Fetal and Neonatal Translational Research (INFANT) and Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland (L.C.K.)
17Kelline Rodems From the Irish Centre for Fetal and Neonatal Translational Research (INFANT) and Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland (L.C.K.)
18Brian Noland From the Irish Centre for Fetal and Neonatal Translational Research (INFANT) and Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland (L.C.K.)
19Michael Raymundo From the Irish Centre for Fetal and Neonatal Translational Research (INFANT) and Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland (L.C.K.)
20James J. Walker From the Irish Centre for Fetal and Neonatal Translational Research (INFANT) and Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland (L.C.K.)

Tóm tắt

More than half of all cases of preeclampsia occur in healthy first-time pregnant women. Our aim was to develop a method to predict those at risk by combining clinical factors and measurements of biomarkers in women recruited to the Screening for Pregnancy Endpoints (SCOPE) study of low-risk nulliparous women. Forty-seven biomarkers identified on the basis of (1) association with preeclampsia, (2) a biological role in placentation, or (3) a role in cellular mechanisms involved in the pathogenesis of preeclampsia were measured in plasma sampled at 14 to 16 weeks’ gestation from 5623 women. The cohort was randomly divided into training (n=3747) and validation (n=1876) cohorts. Preeclampsia developed in 278 (4.9%) women, of whom 28 (0.5%) developed early-onset preeclampsia. The final model for the prediction of preeclampsia included placental growth factor, mean arterial pressure, and body mass index at 14 to 16 weeks’ gestation, the consumption of ≥3 pieces of fruit per day, and mean uterine artery resistance index. The area under the receiver operator curve (95% confidence interval) for this model in training and validation cohorts was 0.73 (0.70–0.77) and 0.68 (0.63–0.74), respectively. A predictive model of early-onset preeclampsia included angiogenin/placental growth factor as a ratio, mean arterial pressure, any pregnancy loss <10 weeks, and mean uterine artery resistance index (area under the receiver operator curve [95% confidence interval] in training and validation cohorts, 0.89 [0.78–1.0] and 0.78 [0.58–0.99], respectively). Neither model included pregnancy-associated plasma protein A, previously reported to predict preeclampsia in populations of mixed parity and risk. In nulliparous women, combining multiple biomarkers and clinical data provided modest prediction of preeclampsia.

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Hypertension

Tập 64 Số 3

644-652

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