First-trimester prediction of preeclampsia in nulliparous women at low risk

Leslie Myatt, Rebecca G. Clifton, James M. Roberts, Catherine Y. Spong, John C. Hauth, Michael W. Varner, John M. Thorp, Brian M. Mercer, Alan M. Peaceman, Susan M. Ramin, Marshall W. Carpenter, Jay D. Iams, Anthony Sciscione, Margaret Harper, Jorge E. Tolosa, George Saade, Yoram Sorokin, Garland D. Anderson

Research output: Contribution to journalArticle

129 Citations (Scopus)

Abstract

Objective: To identify clinical characteristics and biochemical markers in first-trimester samples that would possibly predict the subsequent development of preeclampsia. Methods: We conducted a multicenter observational study in 2,434 nulliparous women at low risk to identify biomarkers that possibly predict preeclampsia. Clinical history, complete blood count, and biochemical markers were assessed in the first trimester. The trophoblast and angiogenesis markers ADAM-12, pregnancy-associated plasma protein-A, placental protein 13, placental growth factor, soluble fms-like tyrosine kinase-1, and endoglin were measured in a case-control subset of 174 women with preeclampsia and 509 women in the control group. Results: Univariable analysis revealed maternal age, race, marital status, years of education, source of medical payment, prenatal caregiver, body mass index (BMI, calculated as weight (kg)/[height (m)]), and systolic blood pressure at enrollment were significantly associated with preeclampsia. Mean platelet volume was greater at enrollment in women who later had development of preeclampsia (median 9.4 compared with 9.0 femtoliter (fl); P=.02). First-trimester concentrations (multiples of the median) of ADAM-12 (1.14 compared with 1.04; P=.003), pregnancy-associated plasma protein-A (0.94 compared with 0.98; P=.04), and placental growth factor (0.83 compared with 1.04; P<.001) were significantly different in women who had development of preeclampsia compared with women in the control group. The optimal multivariable model included African American race, systolic blood pressure, BMI, education level, ADAM-12, pregnancy-associated plasma protein-A, and placental growth factor, and yielded an area under the curve of 0.73 (95% confidence interval 0.69-0.77) and a sensitivity of 46.1% (95% confidence interval 38.3-54.0) for 80% specificity. Conclusion: A multivariable analysis of clinical data and biochemical markers in the first trimester did not identify a model that had clinical utility for predicting preeclampsia in a nulliparous population at low risk.

Original languageEnglish (US)
Pages (from-to)1234-1242
Number of pages9
JournalObstetrics and Gynecology
Volume119
Issue number6
DOIs
StatePublished - Jun 2012

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First Pregnancy Trimester
Pre-Eclampsia
Biomarkers
Pregnancy-Associated Plasma Protein-A
Blood Pressure
Intercellular Signaling Peptides and Proteins
Mean Platelet Volume
Confidence Intervals
Pregnancy Proteins
Vascular Endothelial Growth Factor Receptor-1
Control Groups
Blood Cell Count
Maternal Age
Marital Status
Trophoblasts
Medical Education
African Americans
Caregivers
Multicenter Studies
Area Under Curve

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Myatt, L., Clifton, R. G., Roberts, J. M., Spong, C. Y., Hauth, J. C., Varner, M. W., ... Anderson, G. D. (2012). First-trimester prediction of preeclampsia in nulliparous women at low risk. Obstetrics and Gynecology, 119(6), 1234-1242. https://doi.org/10.1097/AOG.0b013e3182571669

First-trimester prediction of preeclampsia in nulliparous women at low risk. / Myatt, Leslie; Clifton, Rebecca G.; Roberts, James M.; Spong, Catherine Y.; Hauth, John C.; Varner, Michael W.; Thorp, John M.; Mercer, Brian M.; Peaceman, Alan M.; Ramin, Susan M.; Carpenter, Marshall W.; Iams, Jay D.; Sciscione, Anthony; Harper, Margaret; Tolosa, Jorge E.; Saade, George; Sorokin, Yoram; Anderson, Garland D.

In: Obstetrics and Gynecology, Vol. 119, No. 6, 06.2012, p. 1234-1242.

Research output: Contribution to journalArticle

Myatt, L, Clifton, RG, Roberts, JM, Spong, CY, Hauth, JC, Varner, MW, Thorp, JM, Mercer, BM, Peaceman, AM, Ramin, SM, Carpenter, MW, Iams, JD, Sciscione, A, Harper, M, Tolosa, JE, Saade, G, Sorokin, Y & Anderson, GD 2012, 'First-trimester prediction of preeclampsia in nulliparous women at low risk', Obstetrics and Gynecology, vol. 119, no. 6, pp. 1234-1242. https://doi.org/10.1097/AOG.0b013e3182571669
Myatt L, Clifton RG, Roberts JM, Spong CY, Hauth JC, Varner MW et al. First-trimester prediction of preeclampsia in nulliparous women at low risk. Obstetrics and Gynecology. 2012 Jun;119(6):1234-1242. https://doi.org/10.1097/AOG.0b013e3182571669
Myatt, Leslie ; Clifton, Rebecca G. ; Roberts, James M. ; Spong, Catherine Y. ; Hauth, John C. ; Varner, Michael W. ; Thorp, John M. ; Mercer, Brian M. ; Peaceman, Alan M. ; Ramin, Susan M. ; Carpenter, Marshall W. ; Iams, Jay D. ; Sciscione, Anthony ; Harper, Margaret ; Tolosa, Jorge E. ; Saade, George ; Sorokin, Yoram ; Anderson, Garland D. / First-trimester prediction of preeclampsia in nulliparous women at low risk. In: Obstetrics and Gynecology. 2012 ; Vol. 119, No. 6. pp. 1234-1242.
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AU - Hauth, John C.

AU - Varner, Michael W.

AU - Thorp, John M.

AU - Mercer, Brian M.

AU - Peaceman, Alan M.

AU - Ramin, Susan M.

AU - Carpenter, Marshall W.

AU - Iams, Jay D.

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N2 - Objective: To identify clinical characteristics and biochemical markers in first-trimester samples that would possibly predict the subsequent development of preeclampsia. Methods: We conducted a multicenter observational study in 2,434 nulliparous women at low risk to identify biomarkers that possibly predict preeclampsia. Clinical history, complete blood count, and biochemical markers were assessed in the first trimester. The trophoblast and angiogenesis markers ADAM-12, pregnancy-associated plasma protein-A, placental protein 13, placental growth factor, soluble fms-like tyrosine kinase-1, and endoglin were measured in a case-control subset of 174 women with preeclampsia and 509 women in the control group. Results: Univariable analysis revealed maternal age, race, marital status, years of education, source of medical payment, prenatal caregiver, body mass index (BMI, calculated as weight (kg)/[height (m)]), and systolic blood pressure at enrollment were significantly associated with preeclampsia. Mean platelet volume was greater at enrollment in women who later had development of preeclampsia (median 9.4 compared with 9.0 femtoliter (fl); P=.02). First-trimester concentrations (multiples of the median) of ADAM-12 (1.14 compared with 1.04; P=.003), pregnancy-associated plasma protein-A (0.94 compared with 0.98; P=.04), and placental growth factor (0.83 compared with 1.04; P<.001) were significantly different in women who had development of preeclampsia compared with women in the control group. The optimal multivariable model included African American race, systolic blood pressure, BMI, education level, ADAM-12, pregnancy-associated plasma protein-A, and placental growth factor, and yielded an area under the curve of 0.73 (95% confidence interval 0.69-0.77) and a sensitivity of 46.1% (95% confidence interval 38.3-54.0) for 80% specificity. Conclusion: A multivariable analysis of clinical data and biochemical markers in the first trimester did not identify a model that had clinical utility for predicting preeclampsia in a nulliparous population at low risk.

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