Accuracy of competing-risks model in screening for pre-eclampsia by maternal factors and biomarkers at 11-13 weeks' gestation

Journal article


O'Gorman, N., Wright, D., Poon, L.C., Rolnik, D.L., Syngelaki, A., Wright, A., Akolekar, R., Cicero, S., Janga, D., Jani, J., Molina, F.S., de Paco Matallana, C., Papantoniou, N., Persico, N., Plasencia, W., Singh, M. and Nicolaides, K.H. 2017. Accuracy of competing-risks model in screening for pre-eclampsia by maternal factors and biomarkers at 11-13 weeks' gestation. Ultrasound in Obstetrics and Gynecology. 49 (6), pp. 751-755. https://doi.org/10.1002/uog.17399
AuthorsO'Gorman, N., Wright, D., Poon, L.C., Rolnik, D.L., Syngelaki, A., Wright, A., Akolekar, R., Cicero, S., Janga, D., Jani, J., Molina, F.S., de Paco Matallana, C., Papantoniou, N., Persico, N., Plasencia, W., Singh, M. and Nicolaides, K.H.
Abstract

Objective: To examine the diagnostic accuracy of a previously developed model for prediction of preeclampsia (PE) by a combination of maternal factors and biomarkers at 11-13 weeks’ gestation.

Methods: This was a prospective first-trimester multicenter study of screening for PE in 8,775 singleton pregnancies. A previously published algorithm was used for the calculation
of patient-specific risk of PE in each patient. The detection rates (DR) and false positive rates (FPR) for delivery with PE at <32, <37 and >37 weeks were estimated and compared
to those in the dataset used for development of the algorithm.

Results: In the study population there were 239 (2.7%) cases that developed PE, including 17 (0.2%), 59 (0.7%) and 180 (2.0%) at <32, <37 and >37 weeks, respectively. In combined screening by maternal factors, mean arterial pressure, uterine artery pulsatility index and serum placental growth factor the DR was 100% (95% CI 80-100) for PE at <32 weeks, 75% (95% CI 62-85) for PE at <37 weeks and 43% (95% CI 35-50) for PE at >37 weeks, at 10% FPR. These DRs were similar to the estimated rates in the dataset used for development of
the model: 89% (95% CI 79-96) for PE at <32 weeks, 75% (95% CI 70-80) for PE at <37 weeks and 47% (95% CI 44-51) for PE at >37 weeks.

Conclusion: Combination of maternal factors and biomarkers provides effective firsttrimester screening for preterm-PE.

KeywordsFirst-trimester screening; Preeclampsia; Pyramid of pregnancy care; Survival model; Bayes theorem; Uterine artery Doppler; Mean arterial pressure; Pregnancy associated plasma protein-A; Placental growth factor
Year2017
JournalUltrasound in Obstetrics and Gynecology
Journal citation49 (6), pp. 751-755
PublisherWiley
ISSN1469-0705
Digital Object Identifier (DOI)https://doi.org/10.1002/uog.17399
Official URLhttp://doi.org/10.1002/uog.17399
Related URLhttps://pubmed.ncbi.nlm.nih.gov/28067011/
Publication dates
Online09 Jan 2017
Publication process dates
Accepted03 Jan 2017
Deposited10 Jun 2020
Accepted author manuscript
Output statusPublished
References

1. O’Gorman N, Wright D, Syngelaki A, Akolekar R, Wright A, Poon LC, Nicolaides
KH. Competing risks model in screening for preeclampsia by maternal factors and
biomarkers at 11–13 weeks’ gestation. Am J Obstet Gynecol 2016; 214: 103.e1–12.
2. Wright D, Syngelaki A, Akolekar R, Poon LC, Nicolaides KH. Competing risks
model in screening for preeclampsia by maternal characteristics and medical history.
Am J Obstet Gynecol 2015; 213: 62.e1–10.
3. Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig L, LijmerJG
Moher D, Rennie D, de Vet HCW, Kressel HY, Rifai N, Golub RM, Altman
DG, Hooft L, Korevaar DA, Cohen JF, For the STARD Group. STARD 2015: An
updated list of essential items for reporting diagnostic accuracy studies. BMJ 2015;
351: h5527.
4. Poon LC, Zymeri NA, Zamprakou A, Syngelaki A, Nicolaides KH. Protocol for
measurement of mean arterial pressure at 11–13 weeks’ gestation. Fetal Diagn Ther
2012; 31: 42–48.
5. Plasencia W, Maiz N, Bonino S, Kaihura C, Nicolaides KH. Uterine artery Doppler
at 11 + 0to13+ 6 weeks in the prediction of pre-eclampsia. Ultrasound Obstet
Gynecol 2007; 30: 742–749.
6. Wright A, Wright D, Ispas A, Poon LC, Nicolaides KH. Mean arterial pressure in the
three trimesters of pregnancy: effects of maternal characteristics and medical history.
Ultrasound Obstet Gynecol 2015; 45: 698–706.
7. Tayyar A, Guerra L, Wright A, Wright D, Nicolaides KH. Uterine artery pulsatility
index in the three trimesters of pregnancy: effects of maternal characteristics and
medical history. Ultrasound Obstet Gynecol 2015; 45: 689–697.
8. Wright D, Silva M, Papadopoulos S, Wright A, Nicolaides KH. Serum pregnancy
associated plasma protein-A in the three trimesters of pregnancy: effects of
maternal characteristics and medical history. Ultrasound Obstet Gynecol 2015;
46: 42–50.
9. Tsiakkas A, Duvdevani N, Wright A, Wright D, Nicolaides KH. Serum placental
growth factor in the three trimesters of pregnancy: effects of maternal characteristics
and medical history. Ultrasound Obstet Gynecol 2015; 45: 591–598.
10. Robinson HP, Fleming JE. A critical evaluation of sonar crown rump length
measurements. Br J Obstet Gynaecol 1975; 82: 702–710.
11. Brown MA, Lindheimer MD, de Swiet M, Van Assche A, Moutquin JM. The
classification and diagnosis of the hypertensive disorders of pregnancy: Statement
from the international society for the study of hypertension in pregnancy (ISSHP).
Hypertens Pregnancy 2001; 20:IX–XIV.
12. R Development Core Team. R. A language and environment for statistical
computing. R Foundation for Statistical Computing, Vienna, Austria. 2011; ISBN
3-900051-07-0, http://www.R-project.org/.
13. Nicolaides KH. Turning the pyramid of prenatal care. Fetal Diagn Ther 2011; 29:
183–196.
14. Bujold E, Roberge S, Lacasse Y, Bureau M, Audibert F, Marcoux S, Forest JC,
Gigu
`
ere Y. Prevention of preeclampsia and intrauterine growth restriction with
aspirin started in early pregnancy: a meta-analysis. Obstet Gynecol 2010; 116:
402–414.
15. Roberge S, Nicolaides K, Demers S, Villa P, Bujold E. Prevention of perinatal death
and adverse perinatal outcome using low-dose aspirin: a meta-analysis. Ultrasound
Obstet Gynecol 2013;
41: 491–499.
16. Roberge S, Villa P, Nicolaides K, Gigu
`
ereY,VainioM,BakthiA,EbrashyA,Bujold
E. Early administration of low dose aspirin for the prevention of preterm and term
pre-eclampsia: a systematic review and meta-analysis. Fetal Diagn Ther 2012; 31:
141–146.
17. Andrietti S, Silva M, Wright A, Wright D, Nicolaides KH. Competing-risks model
in screening for pre-eclampsia by maternal factors and biomarkers at 35–37 weeks’
gestation. Ultrasound Obstet Gynecol 2016; 48: 72–79.

Permalink -

https://repository.canterbury.ac.uk/item/8vq26/accuracy-of-competing-risks-model-in-screening-for-pre-eclampsia-by-maternal-factors-and-biomarkers-at-11-13-weeks-gestation

  • 1
    total views
  • 1
    total downloads
  • 0
    views this month
  • 0
    downloads this month

Export as

Related outputs

Predicting the risk to develop preeclampsia in the first trimester combining promoter variant -98A/C of LGALS13 (placental protein 13), Black ethnicity, previous preeclampsia, obesity, and maternal age
Madar-Shapiro, L., Karady, I., Trahtenherts, A., Syngelaki, A., Akolekar, R., Poon, L., Cohen, R., Sharabi-Nov, A., Huppertz, B., Sammar, M., Juhasz, K., Than, N.G., Papp, Z., Romero, R., Nicolaides, K.H. and Meiri, H. 2018. Predicting the risk to develop preeclampsia in the first trimester combining promoter variant -98A/C of LGALS13 (placental protein 13), Black ethnicity, previous preeclampsia, obesity, and maternal age. Fetal Diagnosis & Therapy. 43 (4), pp. 250-265. https://doi.org/10.1159/000477933
Risk of miscarriage following amniocentesis and chorionic villus sampling: a systematic review of the literature
Beta, J., Lesmes-Heredia, C., Bedetti, C. and Akolekar, R. 2018. Risk of miscarriage following amniocentesis and chorionic villus sampling: a systematic review of the literature. Minerva Ginecologica. 70 (2), pp. 215-219. https://doi.org/10.23736/S0026-4784.17.04178-8
Fetal major cardiac defects and placental dysfunction at 11-13 weeks' gestation
Fantasia, I., Kasapoglu, D., Kasapoglu, T., Syngelaki, A., Akolekar, R. and Nicolaides, K. H. 2018. Fetal major cardiac defects and placental dysfunction at 11-13 weeks' gestation. Ultrasound in Obstetrics and Gynecology. 51 (2), pp. 194-198. https://doi.org/10.1002/uog.18839
ASPRE trial: incidence of preterm pre-eclampsia in patients fulfilling ACOG and NICE criteria according to risk by FMF algorithm
Allen, A., Poon, L. C., Rolnik, D. L., Tan, M. Y., Delgado, J. L., Tsokaki, T., Akolekar, R., Singh, M., Andrade, W., Efeturk, T., Jani, J. C., Plasencia, W., Papaioannou, G., Blazquez, A. R., Carbone, I. F., Wright, D. and Nicolaides, K. H. 2018. ASPRE trial: incidence of preterm pre-eclampsia in patients fulfilling ACOG and NICE criteria according to risk by FMF algorithm. Ultrasound in Obstetrics and Gynecology. 51 (6), pp. 738-742. https://doi.org/10.1002/uog.19019
Comparison of diagnostic accuracy of early screening for pre-eclampsia by NICE guidelines and a method combining maternal factors and biomarkers: results of SPREE
Tan, M. Y., Wright, D., Syngelaki, A., Akolekar, R., Cicero, S., Janga, D., Singh, M., Greco, E., Wright, A., Maclagan, K., Poon, L. C. and Nicolaides, K. H. 2018. Comparison of diagnostic accuracy of early screening for pre-eclampsia by NICE guidelines and a method combining maternal factors and biomarkers: results of SPREE. Ultrasound in Obstetrics and Gynecology. 51 (6), pp. 743-750.
Ultrasonographic estimation of fetal weight: development of new model and assessment of performance of previous models
Hammami, A., Mazer Zumaeta, A., Syngelaki, A., Akolekar, R. and Nicolaides, K. H. 2018. Ultrasonographic estimation of fetal weight: development of new model and assessment of performance of previous models. Ultrasound in Obstetrics and Gynecology. 52 (1), pp. 35-43. https://doi.org/10.1002/uog.19066
Fetal Medicine Foundation fetal and neonatal population weight charts
Nicolaides, K. H., Wright, D., Syngelaki, A., Wright, A. and Akolekar, R. 2018. Fetal Medicine Foundation fetal and neonatal population weight charts. Ultrasound in Obstetrics and Gynecology. 52 (1), pp. 44-51. https://doi.org/10.1002/uog.19073
Screening for pre-eclampsia by maternal factors and biomarkers at 11-13 weeks' gestation
Tan, M.Y., Syngelaki, A., Poon, L.C., Rolnik, D.L., O'Gorman, N., Delgado, J.L., Akolekar, R., Konstantinidou, L., Tsavdaridou, M., Galeva, S., Ajdacka, U., Molina, F.S., Persico, N., Jani, J.C., Plasencia, W., Greco, E., Papaioannou, G., Wright, A., Wright, D. and Nicolaides, K.H. 2018. Screening for pre-eclampsia by maternal factors and biomarkers at 11-13 weeks' gestation. Ultrasound in Obstetrics and Gynecology. 52 (2), pp. 186-195. https://doi.org/10.1002/uog.19112
Reference ranges for the size of the fetal cardiac outflow tracts from 13 to 36 weeks gestation: a single-center study of over 7000 cases
Vigneswaran, T.V., Akolekar, R., Syngelaki, A., Charakida, M., Allan, L.D., Nicolaides, K.H., Zidere, V. and Simpson, J.M. 2018. Reference ranges for the size of the fetal cardiac outflow tracts from 13 to 36 weeks gestation: a single-center study of over 7000 cases. Circulation Cardiovascular Imaging. 11 (7), p. e007575. https://doi.org/10.1161/CIRCIMAGING.118.007575
Comparison of screening for pre-eclampsia at 31-34 weeks' gestation by sFlt-1/PlGF ratio and a method combining maternal factors with sFlt-1 and PlGF
Tan, M.Y., Wright, D., Koutoulas, L., Akolekar, R. and Nicolaides, K.H. 2017. Comparison of screening for pre-eclampsia at 31-34 weeks' gestation by sFlt-1/PlGF ratio and a method combining maternal factors with sFlt-1 and PlGF. Ultrasound in Obstetrics and Gynecology. 49 (2), pp. 201-208. https://doi.org/10.1002/uog.17307
Proposed clinical management of pregnancies after combined screening for pre-eclampsia at 30-34 weeks' gestation
Wright, D., Dragan, I., Syngelaki, A., Akolekar, R. and Nicolaides, K.H. 2017. Proposed clinical management of pregnancies after combined screening for pre-eclampsia at 30-34 weeks' gestation. Ultrasound in Obstetrics and Gynecology. 49 (2), pp. 194-200. https://doi.org/10.1002/uog.17309
Proposed clinical management of pregnancies after combined screening for pre-eclampsia at 35-37 weeks' gestation
Panaitescu, A.M., Wright, D., Militello, A., Akolekar, R. and Nicolaides, K.H. 2017. Proposed clinical management of pregnancies after combined screening for pre-eclampsia at 35-37 weeks' gestation. Ultrasound in Obstetrics and Gynecology. 50 (3), pp. 383-387. https://doi.org/10.1002/uog.17419
Chronic hypertension and adverse pregnancy outcome: a cohort study
Panaitescu, A.M., Syngelaki, A., Prodan, N., Akolekar, R. and Nicolaides, K.H. 2017. Chronic hypertension and adverse pregnancy outcome: a cohort study. Ultrasound in Obstetrics and Gynecology. 50 (2), pp. 228-235. https://doi.org/10.1002/uog.17493
Impaired placentation in women with chronic hypertension who develop pre-eclampsia
Panaitescu, A.M., Akolekar, R., Kametas, N., Syngelaki, A. and Nicolaides, K.H. 2017. Impaired placentation in women with chronic hypertension who develop pre-eclampsia. Ultrasound in Obstetrics and Gynecology. 50 (4), pp. 496-500. https://doi.org/10.1002/uog.17517
Association of chronic hypertension with birth of small-for-gestational-age neonate
Panaitescu, A.M., Baschat, A.A., Akolekar, R., Syngelaki, A. and Nicolaides, K.H. 2017. Association of chronic hypertension with birth of small-for-gestational-age neonate. Ultrasound in Obstetrics and Gynecology. 50 (3), pp. 361-366. https://doi.org/10.1002/uog.17553
Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia
Rolnik, D.L., Wright, D., Poon, L.C., O'Gorman, N., Syngelaki, A., de Paco Matallana, C., Akolekar, R., Cicero, S., Janga, D., Singh, M., Molina, F.S., Persico, N., Jani, J.C., Plasencia, W., Papaioannou, G., Tenenbaum-Gavish, K., Meiri, H., Gizurarson, S., Maclagan, K. and Nicolaides, K.H. 2017. Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia. The New England Journal of Medicine. 377 (7), pp. 613-622. https://doi.org/10.1056/NEJMoa1704559
Aspirin for evidence-based preeclampsia prevention trial: effect of aspirin in prevention of preterm preeclampsia in subgroups of women according to their characteristics and medical and obstetrical history.
Poon, L.C., Wright, D., Rolnik, D.L., Syngelaki, A., Delgado, J.L., Tsokaki, T., Leipold, G., Akolekar, R., Shearing, S., De Stefani, L., Jani, J.C., Plasencia, W., Evangelinakis, N., Gonzalez-Vanegas, O., Persico, N., Nicolaides, K.H. and Allen, A. 2017. Aspirin for evidence-based preeclampsia prevention trial: effect of aspirin in prevention of preterm preeclampsia in subgroups of women according to their characteristics and medical and obstetrical history. American Journal of Obstetrics & Gynecology. 217 (5), pp. 585.e1- 5.. https://doi.org/10.1016/j.ajog.2017.07.038
Association between insulin resistance and preeclampsia in obese non-diabetic women receiving metformin
Balani, J., Hyer, S., Syngelaki, A., Akolekar, R., Nicolaides, K. H., Johnson, A. and Shehata, H. 2017. Association between insulin resistance and preeclampsia in obese non-diabetic women receiving metformin. Obstetric Medicine. 10, pp. 170-173. https://doi.org/10.1177/1753495X17725465