Different risk-assessment models for prediction of preeclampsia and fetal growth restriction in the first trimester in a high-risk pregnancy – which models are better?

BACKGROUND: An increase in the number of pregnant women with various extragenital and gynecological pathologies and motivation for delayed motherhood form a large cohort of patients with a high risk of adverse obstetric outcomes. In this regard, it is necessary to study new approaches that allow stratification of these risks and personalization of pregnancy management and timing of delivery.

AIM: The aim of this study was to compare the predictive values of using blood placental growth factor and pregnancy-associated plasma protein-A levels in combined first-trimester screening for the prediction of preeclampsia and fetal growth restriction in a high-risk pregnancy.

MATERIALS AND METHODS: This retrospective cohort study enrolled 158 women, who received antenatal care or gave birth on the premises from April 1, 2020 through December 31, 2022. The following comparison groups were defined: pregestational diabetes mellitus (n = 34; group I), chronic arterial hypertension (n = 25; group II); obesity (body mass index more than 30 kg/m²; n = 31; group III), older women (40 years and older) with an assisted reproductive technologies pregnancy (n = 8; group IV), and the control group (n = 60; group V). The endpoints of the study were determined as preeclampsia (early and late forms), fetal growth restriction, and the effect of acetylsalicylic acid administration on the risk of placenta-related complications. Various models were used to evaluate the diagnostic value of pregnancy-associated plasma protein-A and placental growth factor in predicting preeclampsia and fetal growth restriction, including maternal characteristics and history, as well as mean arterial pressure, uterine artery pulsatility index, placental growth factor and pregnancy-associated plasma protein-A levels. Statistical data processing was performed using Prism 9 GraphPad (USA).

RESULTS: In all high-risk groups, there was a significant decrease in placental growth factor levels compared to the control group (p = 0.032). In patients who have developed preeclampsia, placental growth factor levels were statistically lower. Pregnancy-associated plasma protein-A and placental growth factor have demonstrated the greatest validity for predicting preeclampsia [area under curve 0.88 (0.81–0.94), and 0.93 (0.88–0.99)], early [area under curve 0.88 (0.77–0.95), and 0.95 (0.88–0.99)] and late [area under curve 0.86 (0.72–0.9), and 0.91 (0.81–0.97)] forms. Fetal growth restriction prediction was less effective. Administration of acetylsalicylic acid from week 12 to weeks 35–36 of pregnancy contributed to a decrease in the overall risk of developing preeclampsia (relative risk 0.39; 95% confidence interval 0.23–0.65) and fetal growth restriction (in the fetal growth restriction subgroup) (relative risk 0.38; 95% confidence interval 0.12–0.96).

CONCLUSIONS: The most effective approach for predicting preeclampsia and fetal growth restriction should include assessment of maternal factors, mean arterial pressure, uterine artery pulsatility index, and placental growth factor. The combined use of pregnancy-associated plasma protein-A and placental growth factor does not significantly improve prognosis.