Ultrasound Obstet Gynecol. 2022 Apr 25. doi: 10.1002/uog.24918. Online ahead of print.
ABSTRACT
OBJECTIVES: To assess whether pregnancy associated plasma protein-A (PAPP-A) improves or provides equivalent screening performance as placental growth factor (PlGF) when screening for preterm preeclampsia (PE) at 11-13 weeks METHODS: This is a secondary analysis of a non-intervention screening study of 6546 singleton pregnancies prospectively screened for preterm PE in the first trimester between December 2016 and June 2018. Patient-specific risks for preterm PE were estimated by maternal history, mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI), PlGF and PAPP-A. A competing risks model with biomarker expressed in multiple of expected median (MoM) was used. All women and clinicians were unaware of the risk for preterm PE. Effectiveness when screening for preterm PE with and without PAPP-A and PlGF was assessed using the difference in the area under receiver operational curves (AUC). McNemar test was used to compare detection rate at a fixed false positive rate (FPR) of 10%.
RESULTS: 37 women developed preterm PE. The AUC and detection rate at 10% FPR using PlGF in conjunction with history, MAP and UtA-PI were 0.854 and 59.46%, respectively. Corresponding figures when replacing PlGF by PAPP-A or adding PAPP-A to PlGF were 0.813 and 54.05%, and 0.855 and 59.46%. Statistically, non-significant differences were noted in AUC when replacing PlGF with PAPP-A (ΔAUC=0.04; p=0.095) or adding PAPP-A (ΔAUC=0.002; p=0.423). However, on an individual case basis, screening using PlGF in conjunction with MAP and UtA-PI identified three (8.1%) additional pregnancies which developed preterm PE not identified by replacing PlGF with PAPP-A. Adding PAPP-A to history and other biomarkers did not identify any additional pregnancies.
CONCLUSION: On an individual case basis, adopting a screening strategy of using PAPP-A instead of PlGF results in an observed loss of detection consistent with the literature. This article is protected by copyright. All rights reserved.
PMID:35468236 | DOI:10.1002/uog.24918
