Performance of a first-trimester screening of preeclampsia in a routine care low-risk setting

OBJECTIVE: We sought to evaluate the effectiveness of an integrated first-trimester screening test to predict preeclampsia (PE). STUDY DESIGN: A prospective cohort of singleton pregnancies underwent routine first-trimester screening from 2009 through 2011 (n = 5759). A logistic regression-based predictive model for early-and late-onset PE was constructed based on: maternal characteristics; levels of pregnancy-associated plasma protein-A and free beta-human chorionic gonadotropin at 8-12 weeks; and blood pressure and uterine artery Doppler at 11.0-13.6 weeks. RESULTS: Of the 5170 enrolled participants, 136 (2.6%) developed PE (early PE: 26 [0.5%]; late PE: 110 [2.1%]). At 5% and 10% false-positive rates, detection rates were 69.2% and 80.8% for early PE (area under the curve, 0.95; 95% confidence interval, 0.94-0.98) and 29.4% and 39.6% for late PE (area under the curve, 0.71; 95% confidence interval, 0.66-0.76), respectively. CONCLUSION: First-trimester screening combining maternal factors with uterine artery Doppler, blood pressure, and pregnancy-associated plasma protein-A is useful to predict PE in a routine care setting.