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

Journal article


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.
AuthorsTan, M.Y., Wright, D., Koutoulas, L., Akolekar, R. and Nicolaides, K.H.
Abstract

Objective: To estimate the patient-specific risk of preeclampsia (PE) at 31-34 weeks’ gestation by a combination of maternal characteristics and medical history with multiple of the median (MoM) values of serum placental growth factor (PLGF) and serum soluble fms-like tyrosine kinase-1 (sFLT-1) and compare the performance of screening to that achieved by the sFLT-1 to PLGF ratio.

Methods: This was a prospective observational study in women attending for a third-trimester ultrasound scan at 31-34 weeks as part of routine pregnancy care. We estimated the performance of screening of PE with delivery within four weeks of assessment (PE at <4 weeks) and PE from four weeks after assessment and up to 40 weeks’ gestation (PE at 4w-40GW) in screening by the sFLT-1 to PLGF ratio and by a to PLGF ratio and by a method utilizing Bayes theorem to combine maternal factors and MoM values of sFLT-1 and PLGF. The significance of difference in performance of screening between the method utilising Bayes theorem and that of the sFLT-1 to PLGF ratio was assessed by comparison of the areas under the receiver operating characteristic curves (AUROC).

Results: The study population of 8,063 singleton pregnancies included 231 (2.9%) that subsequently developed PE. In the prediction of delivery with PE at <4 weeks the performance of the method utilising Bayes theorem was similar to that of the sFLT-1 to PLGF (AUROC: 0.987, 95%CI 0.979-0.995 vs. 0.988, 95%CI: 0.981-0.994; p=0.961). and at fixed fixed screen positive rate (SPR) of 3.9% the detection rate (DR) was 87.1% for both methods. In contrast, the performance of screening for delivery with PE at 4w-40GW was better with the method utilising Bayes theorem than with the sFLT-1 to PLGF ratio
(AUROC: 0.884, 95%CI 0.854-0.914 vs. 0.818, 95%CI: 0.775--0.860 ; p<0.0001) and at total fixed SPR of 25.7% the DRs were 84.4% vs. 73.0%.

Conclusion: At 31-34 weeks’ gestation the performance of screening for PE at <4 weeks from assessment by the method utilising Bayes theorem is similar to that of the sFLT-1 to
PLGF ratio, but the former is superior to the latter in prediction of PE >>4 weeks.

KeywordsPlacental growth factor; Soluble fms-like tyrosine kinase-1; Preeclampsia; Pyramid of antenatal care
Year2017
JournalUltrasound in Obstetrics and Gynecology
Journal citation49 (2), pp. 201-208
PublisherJohn Wiley & Sons Ltd
ISSN1469-0705
Digital Object Identifier (DOI)doi:10.1002/uog.17307
Official URLhttps://pubmed.ncbi.nlm.nih.gov/27671370/
Publication dates
Online27 Sep 2016
Publication process dates
Accepted15 Sep 2016
Deposited10 Jun 2020
Accepted author manuscript
References

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