Screening for preeclampsia using first-trimester serum markers and uterine artery Doppler in nulliparous women

OBJECTIVE: To evaluate the screening accuracy of pregnancy hypertensive disorders by maternal serum biomarkers and uterine artery Doppler in the first trimester. STUDY DESIGN: Prospectively enrolled nulliparous women had uterine artery Doppler and serum measured at 11-13 weeks. Maternal characteristics, uterine artery Doppler, and serum placental biomarkers (pregnancy-associated plasma protein-A, Inhibin-A, placental protein 13, A disintegrin and metalloprotease 12, free beta-hCG, placental growth factor) were recorded. RESULTS: Among 893 women, 20 (2.2%) had gestational hypertension developed and 40 (4.5%) had preeclampsia developed, including 9 (1.0%) early-onset preeclampsia and 16 (1.8%) severe preeclampsia. A combined screening model with clinical characteristics, pregnancy-associated plasma protein-A, Inhibin-A, and placental growth factor could detect 75% of early-onset preeclampsia at a 10% false-positive rate. After adjustment for clinical variables, uterine artery Doppler, placental protein 13, and A disintegrin and metalloprotease 12 did not improve the diagnostic accuracy. CONCLUSION: A combination of clinical characteristics and first-trimester maternal serum biomarkers (pregnancy-associated plasma protein-A, Inhibin-A, and placental growth factor) provides an accurate screening for early-onset preeclampsia in nulliparous women.