Hypertensive disorders in pregnancy: screening by biophysical and biochemical markers at 11-13 weeks

Objective To examine the performance of screening for pre-eclampsia (PE) and gestational hypertension (GH) by a combination of maternal factors and various biophysical and biochemical markers at 11-13 weeks' gestation. Methods This was a case-control study of 26 cases of early PE, 90 of late PE, 85 of G H and 201 unaffected controls. Maternal history was recorded, the uterine artery with the lowest pulsatility index (L-PI) and mean arterial pressure (MAP) were measured and stored plasma and serum were analyzed for placental growth factor (PlGF), inhibin-A, activin-A, tumor necrosis factor receptor-1, matrix metalloproteinase-9, pentraxin-3 and P-selectin. Results Multivariate logistic regression analysis demonstrated that significant prediction for early PE was provided by maternal factors, MAP, uterine artery L-PI and serum PIGF. Significant prediction of late PE was provided by maternal factors, MAP, uterine artery L-PI, PlGF, activin-A and P-selectin. For GH significant prediction was provided by maternal factors, MAP, uterine artery L-PI and activin-A. In screening by a combination of maternal factors, biophysical and biochemical markers the estimated detection rates, at a 5% false-positive rate, were 88.5% (95% CI, 69.8-97.4%) for early PE, 46.7% (95% CI, 36.1-57.5%) for late PE and 35.3% (95% CI, 25.2-46.4%) for GH. Conclusion Combined biophysical and biochemical testing at 11-13 weeks could effectively identify women at high risk for subsequent development of hypertensive disorders in pregnancy. Copyright (C) 2010 ISUOG. Published by John Wiley & Sons, Ltd.