First-trimester prediction of preeclampsia: Validation of screening algorithms in a Russian population

Kholin A.M., Muminova K.T., Balashov I.S., Khodzhaeva Z.S., Borovikov P.I., Ivanets T.Yu., Gus A.I.

Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, Moscow 117997, Ac. Oparina str. 4, Russia
Objective. To make an external evaluation of the effectiveness of three published algorithms in the first-trimester prediction of preeclampsia (PE) in a prospective cohort study of a Russian population. Material and methods. Clinical and anamnestic factors, echographic parameters (uterine artery pulsatility index), and biochemical markers (PAPP-A, PlGF, and sFlt-1) during singleton pregnancies were prospectively analyzed during combined screening at 11-13 weeks’ gestation. After receiving information on pregnancy outcomes, the risks for early-onset (<34 weeks) or late-onset (≥34 weeks) PE were calculated using the algorithms proposed by Poon (2009), Parra-Cordero (2013), and Crovetto (2015). The effectiveness of predictive algorithms was compared with that presented in the original publications and evaluated for factors explaining the prediction differences. Results. Three algorithms for the prediction of both early- and late-onset PE were examined in 4000 pregnant women. Labor was induced in 29 (0.7%) women before 34 weeks’ pregnancy due to early-onset PE and in 73 (1.8%) women after 34 weeks’ gestation due to late-onset PE. Gestational hypertension was diagnosed in 119 (2.9%) cases. The area under the ROC curve for early-onset PE tests was 0.79 (0.76-0.81), 0.69 (0.66-0.72), and 0.75 (0.72-0.78) and that for late-onset PE tests was 0.74 (0.71-0.77), 0.65 (0.62-0.68), and 0.66 (0.63-0.69). The sensitivity of tests for early-onset PE ranged from 31.6% to 57.8%; that of tests for late-onset PE was 25.5 to 37.2% with an overall false-positive rate of 10%. Conclusion. External validation of algorithms in the first-trimester prediction of PE in a Russian population has demonstrated the high negative predictive value of the sensitivity that is lower than stated in the original studies and, in general, the moderate effectiveness in the prediction of early-onset PE. There is a need for further investigations to determine the most optimal algorithms for predicting PE.

Keywords

preeclampsia
combined first-trimester screening
prognostic model validation
placental growth factor
uterine artery Doppler study

References

1. Sibai B., Dekker G., Kupferminc M. Pre-eclampsia. Lancet. 2005; 365(9461): 785-99.

2. Duley L. The global impact of pre-eclampsia and eclampsia. Semin. Perinatol. 2009; 33(3): 130-7.

3. Савельева Г.М., Шалина Р.И., Курцер М.А., Штабницкий А.М., Куртенок Н.В., Коновалова О.В. Эклампсия в современном акушерстве. Акушерство и гинекология. 2010; 6: 4-9. [Savelyeva G.M., Shalina R.I., Kurtser M.A., Shabnitsky A.M., Kurtenok N.V., Konovalova O.V. Eclampsia in modern obstetrics. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2010; (6): 4-9. (in Russian)]

4. Шувалова М.П., Фролова О.Г., Ратушняк С.С., Гребенник Т.К., Гусева Е.В. Преэклампсия и эклампсия как причина материнской смертности. Акушерство и гинекология. 2014; 8: 81-7. [Shuvalova M.P., Frolova O.G., Ratushnyak S.S., Grebennik T.K., Guseva E.V. Preeclampsia and eclampsia as a cause of maternal death. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2014; (8): 81-7. (in Russian)]

5. Сидорова И.С. Решенные вопросы и нерешенные проблемы преэклампсии в России (редакционная статья). Российский вестник акушера-гинеколога. 2015; 15(2): 4-9. [Sidorova I.S. Solved questions and unsolved problems of pre-eclampsia in Russia (editorial). Rossiyskiy vestnik akushera-ginekologa. 2015; 15 (2): 4-9. (in Russian)]

6. Roberts J.M., Hubel C.A. The two stage model of preeclampsia: variations on the theme. Placenta. 2009; 30(Suppl. A): S32-7.

7. Ходжаева З.С., Холин А.М., Вихляева Е.М. Ранняя и поздняя преэклампсия: парадигмы патобиологии и клиническая практика. Акушерство и гинекология. 2013; 10: 4-11. [Khodzhaeva Z.S., Kholin A.M., Vikhlyaeva E.M. Early and late preeclampsia: Pathobiology paradigms and clinical practice. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2013; (10): 4-11. (in Russian)]

8. Roberge S., Villa P., Nicolaides K., Giguere Y., Vainio M., Bakthi A. et al. Early administration of low-dose aspirin for the prevention of preterm and term preeclampsia: a systematic review and meta-analysis. Fetal Diagn. Ther. 2012; 31(3): 141-6.

9. Bujold E., Roberge S., Nicolaides K.H. Low-dose aspirin for prevention of adverse outcomes related to abnormal placentation. Prenat. Diagn. 2014; 34(7): 642-8.

10. Scholten R.R., Hopman M.T., Sweep F.C., Van de Vlugt M.J., Van Dijk A.P., Oyen W.J. et al. Co-occurrence of cardiovascular and prothrombotic risk factors in women with a history of preeclampsia. Obstet. Gynecol. 2013; 121(1):

11. Akolekar R., Syngelaki A., Poon L., Wright D., Nicolaides K.H. Competing risks model in early screening for preeclampsia by biophysical and biochemical markers. Fetal Diagn. Ther. 2013; 33(1): 8-15.

12. Parra-Cordero M., Rodrigo R., Barja P., Bosco C., Rencoret G., Sepulveda-Martinez A., Quezada S. Prediction of early and late pre-eclampsia from maternal characteristics, uterine artery Doppler and markers of vasculogenesis during first trimester of pregnancy. Ultrasound Obstet. Gynecol. 2013; 41(5): 538-44.

13. Park F.J., Leung C.H., Poon L.C., Williams P.F., Rothwell S.J., Hyett J.A. Clinical evaluation of a first trimester algorithm predicting the risk of hypertensive disease of pregnancy. Aust. N. Z. J. Obstet. Gynaecol. 2013; 53(6): 532-9.

14. Odibo A.O., Zhong Y., Goetzinger K.R., Odibo L., Bick J.L., Bower C.R., Nelson D.M. First-trimester placental protein 13, PAPP-A, uterine artery Doppler and maternal characteristics in the prediction of pre-eclampsia. Placenta. 2011; 32(8): 598-602.

15. Kuc S., Koster M.P., Franx A., Schielen P.C., Visser G.H. Maternal characteristics, mean arterial pressure and serum markers in early prediction of preeclampsia. PloS One. 2013; 8(5): e63546.

16. Caradeux J., Serra R., Nien J.K., Perez-Sepulveda A., Schepeler M., Guerra F. et al. First trimester prediction of early onset preeclampsia using demographic, clinical, and sonographic data: a cohort study. Prenat. Diagn. 2013;33(8): 732-6.

17. Crovetto F., Figueras F., Triunfo S., Crispi F., Rodriguez-Sureda V., Dominguez C. et al. First trimester screening for early and late preeclampsia based on maternal characteristics, biophysical parameters, and angiogenic factors. Prenat. Diagn. 2015; 35(2):183-91.

18. Kleinrouweler C.E., Cheong-See F.M., Collins G.S., Kwee A., Thangaratinam S., Khan K.S. et al. Prognostic models in obstetrics: available, but far from applicable. Am. J. Obstet. Gynecol. 2016; 214(1): 79-90. e36.

19. Савельева Г.М., Бугеренко Е.Ю., Панина О.Б. Прогностическая значимость нарушения маточно-плацентарного кровообращения в I триметсре беременности у пациенток с отягощенным акушерским анамнезом. Вестник Российской академии медицинских наук. 2013; 7: 4-8. [Savelyeva G.M., Bugerenko E.Yu., Panina O.B. Prognostic significance of a violation of uteroplacental circulation in the first trimester of pregnancy in patients with a history of obstetric anamnesis. Bulletin of the Russian Academy of Medical Sciences. 2013; 7: 4-8. (in Russian)]

20. Poon L.C., Kametas N.A., Maiz N., Akolekar R., Nicolaides K.H. First-trimester prediction of hypertensive disorders in pregnancy. Hypertension. 2009; 53(5): 812-8.

21. Poon L.C., Kametas N.A., Chelemen T., Leal A., Nicolaides K.H. Maternal risk factors for hypertensive disorders in pregnancy: a multivariate approach. J. Hum. Hypertens. 2010; 24(2): 104-10.

22. Cuckle H.S. Screening for pre-eclampsia--lessons from aneuploidy screening. Placenta. 2011; 32(Suppl.): S42-8.

23. Tunstall-Pedoe H., Kuulasmaa K., Mahonen M., Tolonen H., Ruokokoski E., Amouyel P. Contribution of trends in survival and coronary-event rates to changes in coronary heart disease mortality: 10-year results from 37 WHO MONICA project populations. Monitoring trends and determinants in cardiovascular disease. Lancet. 1999; 353(9164): 1547-57.

24. Гафаров В.В., Громова Е.А., Гагулин И.В., Панов Д.О., Гафарова А.В. Риск развития ассоциированных с атеросклерозом заболеваний (инфаркта миокарда, инсульта) и жизненное истощение у населения в России. Атеросклероз. 2017; 13(1): 19-28. [Gafarov V.V., Gromova E.A., Gagulin I.V., Panov D.O., Gafarova A.V. The risk of developing associated with atherosclerosis diseases (myocardial infarction, stroke) and life exhaustion in the population in Russia. Ateroskleroz. 2017; 13 (1): 19-28. (in Russian)]

25. Гайнулин Ш.М., Лазебник Л.Б., Назаренко И.В., Дроздов В.Н. Табакокурение и риск сердечно-сосудистых заболеваний среди трудоспособного населения г. Москвы. Российский кардиологический журнал. 2006; 57(1): 5-7. [Gainulin Sh.M., Lazebnik L.B., Nazarenko I.V., Drozdov V.N. Tobacco smoking and the risk of cardiovascular diseases among the able-bodied population of Moscow. Russian Cardiology Journal. 2006; 57 (1): 5-7. (in Russian)]

26. Tranquilli A.L., Dekker G., Magee L., Roberts J., Sibai B.M., Steyn W. et al. The classification, diagnosis and management of the hypertensive disorders of pregnancy: A revised statement from the ISSHP. Pregnancy Hypertens. 2014; 4(2): 97-104.

27. Федеральные клинические рекомендации. Гипертензивные расстройства во время беременности, в родах и послеродовом периоде. Преэклампсия. Эклампсия. М.: Российское общество акушеров-гинекологов; 2013. [Federal clinical guidelines. Hypertensive disorders during pregnancy, during childbirth and the postpartum period. Preeclampsia. Eclampsia. Moscow: Russian Society of Obstetricians and Gynecologists; 2013. (in Russian)]

28. Crovetto F., Figueras F., Triunfo S., Crispi F., Rodriguez-Sureda V., Peguero A. et al. Added value of angiogenic factors for the prediction of early and late preeclampsia in the first trimester of pregnancy. Fetal Diagn. Ther. 2014; 35(4): 258-66.

29. Park F., Russo K., Williams P., Pelosi M., Puddephatt R., Walter M. et al. Prediction and prevention of early-onset pre-eclampsia: impact of aspirin after first-trimester screening. Ultrasound Obstet. Gynecol. 2015; 46(4): 419-23.

30. Skrastad R., Hov G., Blaas H.G., Romundstad P., Salvesen K. Risk assessment for preeclampsia in nulliparous women at 11-13 weeks gestational age: prospective evaluation of two algorithms. BJOG. 2015; 122(13): 1781-8

31. Oliveira N., Magder L.S., Blitzer M.G., Baschat A.A. First-trimester prediction of pre-eclampsia: external validity of algorithms in a prospectively enrolled cohort. Ultrasound Obstet. Gynecol. 2014; 44(3): 279-85.

32. Farina A., Rapacchia G., Freni Sterrantino A., Pula G., Morano D., Rizzo N. Prospective evaluation of ultrasound and biochemical-based multivariable models for the prediction of late pre-eclampsia. Prenat. Diagn. 2011; 31(12): 1147-52.

33. Spencer R.N., Carr D.J., David A.L. Treatment of poor placentation and the prevention of associated adverse outcomes--what does the future hold? Prenat. Diagn. 2014; 34(7): 677-84.

Received 21.04.2017

Accepted 28.04.2017

About the Authors

Alexey Kholin, M.D., Associate Researcher, Department of Maternal Fetal Medicine, Research Center of Obstetrics, Gynecology and Perinatology,
Ministry of Health of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4. E-mail: a_kholin@oparina4.ru
Kamilla Muminova, M.D. Associate Researcher, Department of Maternal Fetel Medicine, Research Center of Obstetrics, Gynecology and Perinatology,
Ministry of Health of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4. E-mail: k_mimonova@oparina4.ru
Ivan Balashov, M.D., Associate Reseracher, Laboratory of Bioinformatics, Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia.
117997, Russia, Moscow, Ac. Oparina str. 4. E-mail: k_mimonova@oparina4.ru
Zulfiya Khodzhaeva, M.D., Ph.D., Professor, Head of Department, Department of Maternal-Fetal Medicine, Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4. E-mail: z_khodzhaeva@oparina4.ru
Pavel Borovikov, Head of Department, Laboratory of Bioinformatics, Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia.
117997, Russia, Moscow, Ac. Oparina str. 4. E-mail: p_borovikov@oparina4.ru
Tatyana Ivanets, M.D., Head of Scientific and Diagnostic Laboratory, Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia.
117997, Russia, Moscow, Ac. Oparina str. 4. E-mail: t_ivanets@oparina4.ru
Alexander Gus, M.D., Ph.D., Head of Ultrasound Department, Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia.
117997, Russia, Moscow, Ac. Oparina str. 4. E-mail: a_gus@oparina4.ru

For citations: Kholin A.M., Muminova K.T., Balashov I.S., Khodzhaeva Z.S., Borovikov P.I., Ivanets T.Yu., Gus A.I. First-trimester prediction of preeclampsia: Validation of screening algorithms in a Russian population.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2017; (8): 74-84. (in Russian)
http://dx.doi.org/10.18565/aig.2017.8.74-84

Similar Articles

By continuing to use our site, you consent to the processing of cookies that ensure the proper functioning of the site.