Prospective evaluation of screening performance of first-trimester prediction models for preterm preeclampsia in an Asian population
Publication in refereed journal


摘要Background: The administration of aspirin <16 weeks’ gestation to high risk women for preeclampsia (PE) has been shown to reduce the rate of preterm PE by 65%. The traditional approach to identify such women at risk is based on risk factors from maternal characteristics, obstetrics, and medical history as recommended by the American College of Obstetricians and Gynecologists (ACOG) and the National Institute for Health and Care Excellence (NICE). An alternative approach to screening for PE has been developed by the Fetal Medicine Foundation (FMF). This approach allows estimation of patient-specific risks of PE requiring delivery before a specified gestational age with the use of Bayes theorem-based model.
Objective: To examine the diagnostic accuracy of the FMF Bayes theorem-based model, the ACOG and the NICE recommendations for the prediction of preterm PE at 11-13+6 weeks’ gestation in a large Asian population
Methods: This was a prospective, non-intervention, multicenter study in 10,935 singleton pregnancies at 11-13+6 weeks’ gestation in 11 recruiting centers across seven regions in Asia between December 2016 and June 2018. Maternal characteristics, medical, obstetric, and drug history were recorded. Mean arterial pressure (MAP) and uterine artery pulsatility index (UtA-PI) were measured according to standardized protocols. Maternal serum placental growth factor (PlGF) concentrations were measured by automated analyzers. The measured values of MAP, UtA-PI, and PlGF were converted into multiple of medians (MoMs). The FMF Bayes theorem-based model was used for the calculation of patient-specific risk of PE at <37 weeks (preterm PE) and at any gestation (all PE) in each participant. The performance of screening for preterm PE and all PE by a combination of maternal factors, MAP, UtA-PI, and PlGF (triple test) was evaluated with the adjustment of aspirin use. We examined the predictive performance of the model by the use of receiver operating characteristic curve and calibration by measurements of calibration slope and calibration-in-the large. The detection rate of screening by the FMF Bayes theorem-based model was compared to that derived from the application of ACOG and NICE recommendations.
Results: There were 224 (2.05%) women that developed PE, including 73 cases (0.67%) of preterm PE. In pregnancies with preterm PE, the mean MoM values of MAP and UtA-PI were significantly higher (MAP: 1.099 vs. 1.008; p<0.001; UtA-PI: 1.188 vs 1.063; p=0.006), and the mean PlGF MoM was significantly lower (0.760 vs. 1.100; p<0.001) than in women without PE. The FMF triple test achieved detection rates of 48.2%, 64.0%, 71.8% and 75.8%, at 5%, 10%, 15% and 20% fixed false-positive rates, respectively, for the prediction of preterm PE. These were comparable to those of previously published data from the FMF study. Screening using ACOG recommendations achieved detection rate of 54.6% at 20.4% false-positive rate. The detection rate with the use of NICE guideline was 26.3% at 5.5% false-positive rate.
Conclusion: Based on a large number of women, this study has demonstrated that the FMF Bayes theorem-based model is effective in predicting preterm PE in Asian population and this method of screening is superior to the approach recommended by ACOG and NICE. We have also shown that the FMF prediction model can be implemented as part of routine prenatal care through the use of the existing infrastructure of routine prenatal care.
著者Chaemsaithong Piya , Pooh Ritsuko K. , Zheng Mingming , Ma Runmei , Chaiyasit Noppadol , Tokunaka Mayumi , Shaw Steven W. , Seshadri Suresh , Choolani Mahesh , Wataganara Tuangsit , Yeo George S.H. , Wright Alan , Leung Wing Cheong , Sekizawa Akihiko , Hu Yali , Naruse Katsuhiko , Saito Shigeru , Sahota Daljit , Leung Tak Yeung, Poon Liona C.
期刊名稱American Journal of Obstetrics and Gynecology
頁次650.e1 - 650.e16
關鍵詞American College of Obstetricians and Gynecologists (ACOG), Asian population, Bayes theorem, Fetal Medicine Foundation (FMF), MAP, National Institute for Health and Care Excellence (NICE), UtA-PI, aspirin, biomarker, detection rate, false-positive rate, hypertension, multiples of the median (MoM), placental growth factor (PlGF), prediction model, preeclampsia, pulsatility index, screening, validation

上次更新時間 2020-02-07 於 00:57