Email this article The prediction of different phenotypes of preeclampsia in the first trimester of pregnancy (two-center retrospective study)
- Authors: Shchekleina K.V.1,2, Terekhina V.Y.1, Chaban E.V.3, Nikolayeva M.G.1,4
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Affiliations:
- Altay State Medical University
- Altay Regional Clinical Perinatal Center
- North-Western State Medical University named after I.I. Mechnikov
- National Medical Research Center for Hematology, Altay Branch
- Issue: Vol 71, No 1 (2022)
- Pages: 91-100
- Section: Original Research
- URL: https://journals.eco-vector.com/jowd/article/view/76951
- DOI: https://doi.org/10.17816/JOWD76951
- ID: 76951
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Abstract
AIM: The aim of this study was to determine the effectiveness of predicting the development of placental or maternal preeclampsia (PE) by clinical and anamnestic risk factors and results of the combined screening in first trimester of pregnancy.
MATERIALS AND METHODS: This two-center retrospective case-control study included the data analysis of somatic status, the obstetric and gynecologic anamnesis, and the results of the combined screening of 373 women in the first trimester of pregnancy. The control group consisted of 200 women with physiological course of pregnancy and labor. The main group comprised 173 patients whose pregnancy was complicated by early-onset (n = 44, 25%) or severe late-onset (n = 129, 75%) PE. We analyzed more than 100 clinical and anamnestic risk factors for PE implementation and evaluated the risk of developing PE at 11.0-13.6 weeks of gestation using the Fetal Medicine Foundation calculator.
RESULTS: Maternal risk factors for PE development are identical for clinical phenotypes, except for the family anamnesis of arterial vascular accidents in first-line relatives under 45 years of age, which are significantly interfaced to risk of placental PE development (OR 6.38, 95% CI 2.00–2.28; p = 0.0017). A comprehensive assessment of clinical and anamnestic data at 11.0-13.6 weeks of gestation allows for predicting the implementation of maternal severe PE in 36.7% of cases and placental PE in 29.6% of cases with an identical false positive rate of 10.5%. Carrying out the combined screening in the first trimester allows for determining the risk of PE development up to 37 weeks without differentiation by clinical phenotypes, with a test sensitivity of 53.9% at a false positive rate of 34.7%.
CONCLUSIONS: The prediction of placental or maternal PE development in the first trimester of pregnancy is possible only by maternal, clinical and anamnestic risk factors with a low predictive value of the test. Carrying out the combined screening with the inclusion of maternal risk factors, uterine artery pulsation index and pregnancy-associated plasma protein-A level increases the predictive value of the test for PE development up to 37 weeks from 37.6% to 53.6% at a high rate of false positive results. Validation of medical technologies for predicting clinical PE phenotypes in the population of women, taking into account a territorial origin and risk factors, will allow for defining the shortcomings of the model and improving its predictive value.
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About the authors
Ksenia V. Shchekleina
Altay State Medical University; Altay Regional Clinical Perinatal Center
Author for correspondence.
Email: schekleinakv@gmail.com
ORCID iD: 0000-0001-9968-0744
SPIN-code: 2290-7267
MD, obstetrician-gynecologist, ultrasonographer at the fetal antenatal protection center, junior researcher of the Hemostatic laboratory
Russian Federation, 40, Lenin Av., Barnaul, 656038; 154, Fomin Street, Barnaul, 656045Vasilisa Yu. Terekhina
Altay State Medical University
Email: vasutka_07@mail.ru
ORCID iD: 0000-0003-0695-6145
MD, assistant of The Department of Obstetrics and Gynecology
Russian Federation, 40, Lenin Av., Barnaul, 656038Ekaterina V. Chaban
North-Western State Medical University named after I.I. Mechnikov
Email: hana-nana@mail.ru
ORCID iD: 0000-0002-4830-3460
SPIN-code: 5208-1089
5th year student of General Medicine Faculty
Russian Federation, 47, Piskarevsky Avenue, St. Petersburg, 195067Maria G. Nikolayeva
Altay State Medical University; National Medical Research Center for Hematology, Altay Branch
Email: nikolmg@yandex.ru
ORCID iD: 0000-0001-9459-5698
Scopus Author ID: 57191960907
MD, PhD, Dr. Sci. (Med.), Assistant Professor, Professor, The Department of Obstetrics and Gynecology, senior researcher
Russian Federation, 40, Lenin Av., Barnaul, 656038; BarnaulReferences
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