Added value in low-risk pregnancies of longitudinal changes in uterine Doppler and circulating angiogenic factors during the third trimester in predicting term preeclampsia.

IF 1.6 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Fetal Diagnosis and Therapy Pub Date : 2024-11-04 DOI:10.1159/000541731
Lucie Roubalova, Vladimira Kroutilova, Maria Fernanda Lopez-G Tinajero, Judit Martinez-Egea, Claudia Pumarola, Francesc Figueras, Marek Lubusky
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Abstract

Introduction: To assess the relationship between longitudinal changes in the uterine Doppler velocimetry and the maternal profile of angiogenic factors in the third trimester of pregnancy and to assess their ability to predict term preeclampsia.

Methods: A cohort of low-risk pregnant women was constructed at second trimester routine scan and scheduled for a uterine Doppler evaluation and measurement of the circulating levels of angiogenic factors at ~30 and ~36 weeks. The performance of both parameters at both time-points and their change over time from the first to the second measurement in predicting term preeclampsia was evaluated by logistic regression and receiver operating characteristic curve (ROC) analyses.

Results: A total of 1172 women were analyzed, of which 28 (2.4%) women developed term preeclampsia. At ~30 weeks, a model including the ratio sFlt-1/PlGF (fms-like tyrosine kinase-1/placental growth factor) and the uterine Doppler explained 16.2% of the uncertainty of developing term preeclampsia, while at ~36 weeks the same variables explained 25.2% [p<0.001]. A model including the longitudinal changes of both predictors had an R2 of 26.8%, which was not significantly different from that of the ~36 weeks evaluation [p=0.45]. The area under the curve (AUC) of the ~36 weeks sFlt-1/PlGF ratio was significantly higher than at ~30 weeks (0.86 [0.77-0.94] vs. 0.81 [0.73-0.9]; p=0.043). The AUC of the 30-to-36 week change of the sFlt-1/PlGF ratio (0.85 [0.77-0.94]) did not significantly differ from that of at ~36 weeks (p=0.82). At ~36 weeks, for a 10% of false positives, the sFlt-1/PlGF ratio had a detection rate of 71.4%, with positive and negative likelihood ratios of 7.3 and 0.32, respectively.

Conclusion: A cross-sectional measurement of the sFlt-1/PlGF ratio outperforms uterine Doppler in predicting term preeclampsia. The combination of both markers does not improve such prediction, nor the evaluation of the longitudinal changes between ~30 and ~36 weeks.

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在低危妊娠中,子宫多普勒和循环血管生成因子在妊娠三个月内的纵向变化在预测期前子痫方面的附加值。
引言目的:评估妊娠三个月时子宫多普勒速度测量的纵向变化与母体血管生成因子概况之间的关系,并评估其预测子痫前期的能力:方法:在妊娠后三个月常规扫描时建立低危孕妇队列,并计划在妊娠约 30 周和 36 周时进行子宫多普勒评估和血管生成因子循环水平测量。通过逻辑回归和接收器操作特征曲线(ROC)分析,评估了这两个时间点的两个参数及其从第一次测量到第二次测量的时间变化在预测子痫前期方面的性能:共对 1172 名妇女进行了分析,其中 28 名妇女(2.4%)出现了足月子痫前期。在妊娠约 30 周时,包括 sFlt-1/PlGF(类酪氨酸激酶-1/胎盘生长因子)比率和子宫多普勒在内的模型可解释 16.2% 的足月子痫前期不确定性,而在妊娠约 36 周时,同样的变量可解释 25.2% 的不确定性[p结论:在预测足月子痫前期方面,sFlt-1/PlGF 比率的横断面测量结果优于子宫多普勒。将这两种标记物结合使用并不能提高预测效果,也不能评估在 ~30 周和 ~36 周之间的纵向变化。
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来源期刊
Fetal Diagnosis and Therapy
Fetal Diagnosis and Therapy 医学-妇产科学
CiteScore
4.70
自引率
9.10%
发文量
48
审稿时长
6-12 weeks
期刊介绍: The first journal to focus on the fetus as a patient, ''Fetal Diagnosis and Therapy'' provides a wide range of biomedical specialists with a single source of reports encompassing the common discipline of fetal medicine.
期刊最新文献
Added value in low-risk pregnancies of longitudinal changes in uterine Doppler and circulating angiogenic factors during the third trimester in predicting term preeclampsia. Sequence of events leading to medical abortion for fetal indications after 34 weeks' gestation: 23 years of experience in a single medical center. Postnatal outcomes of fetal variants of unknown significance in prenatal CMA: A single-center study. Fetal Hypoplastic Left Heart Syndrome with Intact Atrial Septum: From successful in-utero stenting to subtotal stent-occlusion - a case report. Utility of 3-Dimensional Modeling in Prenatally Diagnosed Large Fetal Neck Mass.
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