Performance of Fetal Medicine Foundation algorithm for first trimester preeclampsia screening in an indigenous south Asian population

BMC Pregnancy and Childbirth

P. Vanamail¹  Daljit Singh Sahota²  Anita Kaul³  Smriti Prasad⁴  Akshatha Sharma⁵  Saloni Arora⁵ 

[1] All India Institute of Medical Sciences, New Delhi, India;Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong Prince of Wales Hospital, Shatin, SAR, Hong Kong;Head of the Department and Clinical Coordinator, Apollo Centre for Fetal Medicine, Indraprastha Apollo Hospital, New Delhi, India;Indraprastha Apollo Hospitals, New Delhi, India;New Delhi, India;

关键词: Pre-eclampsia;    South Asian;    Screening;    1st trimester;    Uterine artery Pulsatility index;    Mean arterial pressure;    Placental growth factor;    Pregnancy associated plasma protein-a;   

DOI  :  10.1186/s12884-021-04283-6

来源: Springer

【 摘 要 】

BackgroundTo evaluate the performance of the Fetal Medicine Foundation (FMF) preterm preeclampsia (PE) screening algorithm in an indigenous South Asian population.MethodsThis was a prospective observational cohort study conducted in a tertiary maternal fetal unit in Delhi, India over 2 years. The study population comprised of 1863 women carrying a singleton pregnancy and of South Asian ethnicity who were screened for preterm pre-eclampsia (PE) between 11 and 14 weeks of gestation using Mean Arterial Pressure (MAP), transvaginal Mean Uterine Artery Pulsatility Index (UtAPI) and biochemical markers - Pregnancy Associated Plasma Protein-A (PAPP-A) and Placental Growth Factor.. Absolutemeasurements of noted biomarkers were converted to multiples of the expected gestational median (MoMS) which were then used to estimate risk for preterm PE < 37 weeks using Astraia software. Women with preterm PE risk of ≥1:100 was classified as as high risk. Detection rates (DR) at 10% false positive rate were calculated after adjusting for prophylactic aspirin use (either 75 or 150 mg).ResultsThe incidence of PE and preterm PE were 3.17% (59/1863) and 1.34% (25/1863) respectively. PAPP-A and PlGF MoM distribution medians were 0.86 and 0.87 MoM and significantly deviated from 1 MoM. 431 (23.1%) women had a risk of ≥1:100, 75 (17.8%) of who received aspirin. Unadjusted DR using ≥1:100 threshold was 76%.Estimated DRs for a fixed 10% FPR ranged from 52.5 to 80% depending on biomarker combination after recentering MoMs and adjusting for aspirin use.ConclusionThe FMF algorithm whilst performing satisfactorily could still be further improved to ensure that biophysical and biochemical markers are correctly adjusted for indigenous South Asian women.

【 授权许可】

CC BY