Jianping Chen1, Depeng Zhao1,2, Yang Liu1,3, Jia Zhou1, Gang Zou1, Yun Zhang1, Ming Guo1, Tao Duan1, Tim Van Mieghem4, Luming Sun1. 1. Department of Fetal Medicine and Prenatal Diagnosis Center, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China. 2. Department of Reproductive Medicine, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, China. 3. Shanghai Putuo District Maternity and Infant Hospital Corporation, Shanghai, China. 4. Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada.
Abstract
INTRODUCTION: Preeclampsia affects about 10% of twin pregnancies and significantly increases the risk of adverse pregnancy outcomes. However, screening models for preeclampsia in twin pregnancies remains elusive. The present study aimed to evaluate the performance of a multi-marker first trimester preeclampsia screening model in low-risk twin pregnancies. MATERIAL AND METHODS: Between 2014 and 2017, we prospectively assessed first trimester biomarkers for preeclampsia in a 'low-risk' twin pregnancy cohort at a single center. Multiple logistic regression was used to determine significant predictors for early preeclampsia (occurring prior to 34 weeks) and late preeclampsia (occurring after 34 weeks). The performance of the screening models fitted using the significant predictors was calculated using receiver operating characteristics curves, and internal validation was performed using bootstrapping. RESULTS: A total of 769 twin pregnancies were included in the study. Early preeclampsia and late preeclampsia developed in 27 (3.5%) and 59 (7.7%) cases, respectively. Logistic regression analyses showed that maternal age, body mass index, mean artery pressure, and placental growth factor were significant predictors for early preeclampsia; maternal age, body mass index, mean artery pressure and pregnancy-associated plasma protein A were significant for late preeclampsia; uterine artery pulsatility index was not predictive of either early or late preeclampsia. For the fitted screening model of early and late preeclampsia, the areas under receiver operating characteristics curves were 0.82 (95% CI: 0.76, 0.88) and 0.66 (95% CI: 0.59, 0.73), which were expected to decrease to 0.77 and 0.60 respectively based on bootstrapping; the positive predictive values were 10.2% and 12.5%; and the estimated detection rates were 40.7% and 22.0%, respectively, at a false-positive rate of 10%. CONCLUSIONS: A multi-marker screening model for preeclampsia in low-risk twin pregnancies, using a modified version of Fetal Medicine Foundation predictors in singletons, performs less well. Uterine artery pulsatility index is of little value in screening for preeclampsia in low-risk twin pregnancies. This article is protected by copyright. All rights reserved.
INTRODUCTION: Preeclampsia affects about 10% of twin pregnancies and significantly increases the risk of adverse pregnancy outcomes. However, screening models for preeclampsia in twin pregnancies remains elusive. The present study aimed to evaluate the performance of a multi-marker first trimester preeclampsia screening model in low-risk twin pregnancies. MATERIAL AND METHODS: Between 2014 and 2017, we prospectively assessed first trimester biomarkers for preeclampsia in a 'low-risk' twin pregnancy cohort at a single center. Multiple logistic regression was used to determine significant predictors for early preeclampsia (occurring prior to 34 weeks) and late preeclampsia (occurring after 34 weeks). The performance of the screening models fitted using the significant predictors was calculated using receiver operating characteristics curves, and internal validation was performed using bootstrapping. RESULTS: A total of 769 twin pregnancies were included in the study. Early preeclampsia and late preeclampsia developed in 27 (3.5%) and 59 (7.7%) cases, respectively. Logistic regression analyses showed that maternal age, body mass index, mean artery pressure, and placental growth factor were significant predictors for early preeclampsia; maternal age, body mass index, mean artery pressure and pregnancy-associated plasma protein A were significant for late preeclampsia; uterine artery pulsatility index was not predictive of either early or late preeclampsia. For the fitted screening model of early and late preeclampsia, the areas under receiver operating characteristics curves were 0.82 (95% CI: 0.76, 0.88) and 0.66 (95% CI: 0.59, 0.73), which were expected to decrease to 0.77 and 0.60 respectively based on bootstrapping; the positive predictive values were 10.2% and 12.5%; and the estimated detection rates were 40.7% and 22.0%, respectively, at a false-positive rate of 10%. CONCLUSIONS: A multi-marker screening model for preeclampsia in low-risk twin pregnancies, using a modified version of Fetal Medicine Foundation predictors in singletons, performs less well. Uterine artery pulsatility index is of little value in screening for preeclampsia in low-risk twin pregnancies. This article is protected by copyright. All rights reserved.
Entities:
Keywords:
biomarkers; first trimester screening; low-risk twin pregnancies; prediction; preeclampsia; twin pregnancies; uterine artery pulsatility index