A risk model of prenatal screening markers in first trimester for predicting hypertensive disorders of pregnancy

Yiming Chen; Zhen Xie; Xue Wang; Qingxin Xiao; Xiao Lu; Sha Lu; Yezhen Shi; Shaolei Lv

doi:10.1007/s13167-020-00212-3

A risk model of prenatal screening markers in first trimester for predicting hypertensive disorders of pregnancy

EPMA J. 2020 Jun 19;11(3):343-353. doi: 10.1007/s13167-020-00212-3. eCollection 2020 Sep.

Authors

Yiming Chen^#¹, Zhen Xie^#², Xue Wang^#³, Qingxin Xiao⁴, Xiao Lu⁴, Sha Lu¹, Yezhen Shi⁴, Shaolei Lv⁴

Affiliations

¹ Department of Prenatal Diagnosis and Screening Center, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital), No. 369, Kunpeng Road, Shangcheng District, Zhejiang, 310008 Hangzhou China.
² Department of Obstetrics, Hangzhou Women's Hospital (Hangzhou Maternal and Child Health Care Hospital), Zhejiang, 310008 Hangzhou China.
³ Nanjing Medical University, Nanjing, 210000 Jiangsu China.
⁴ Data Analysis Department, Zhejiang Biosan Biochemical Technologies Co., Ltd, Zhejiang, 310012 Hangzhou China.

^# Contributed equally.

Abstract

Background: We aimed to construct a risk model to assess the diagnostic value of predicting hypertensive disorders of pregnancy (HDPs) by screening a range of prenatal markers, including pregnancy-associated plasma protein A (PAPP-A), free beta-human chorionic gonadotropin (free β-hCG), and fetal nuchal translucency (NT).

Method: We analyzed 902 women, classified into four groups: healthy gravidas (n = 680, controls), gravidas with gestational hypertension (n = 61; GH), gravidas with preeclampsia (n = 90; PE), and gravidas with severe preeclampsia (n = 71, SPE). We then compared the multiple of median (MoM) of PAPP-A, free β-hCG, and NT. A risk model was constructed and receiver operating characteristic curve (ROC) analysis was used to diagnose HDPs.

Results: Levels of PAPP-A and free β-hCG levels in the GH, PE, and SPE groups were significantly lower than those in the control group (χ ² = 7.522, P = 0.001; χ ² = 17.775, P < 0.001). NT did not differ significantly when compared across all four groups (χ ² = 1.592, P > 0.05). When the cut-off values for PAPP-A and free β-hCG were 0.795 MoM and 1.185 MoM, the corresponding sensitivities and specificities were 0.514 and 0.635, and 0.734 and 0.450, respectively. The best risk calculation featured PAPP-A, free β-hCG, and NT; this model exhibited the highest diagnostic value in the SPE group, followed by the GH group and then the PE group.

Conclusion: The use of prenatal screening markers during early pregnancy can identify fetal aneuploidy and can also predict HDPs. The development of innovative screening strategies for gravidas and the targeted prevention of HDPs in high-risk gravidas are essential for perinatal care and early intervention, thus creating significant opportunities for predictive and preventive personalized medicine. In our study, we found that the combination of a series of prenatal screening markers in early pregnancy is better than a single marker; our data clearly demonstrate the diagnostic value of combining PAPP-A, free β-hCG, and NT for patients with SPE.

Keywords: Free beta-human chorionic gonadotropin; Hypertensive disorders of pregnancy; Nuchal translucency; Predictive preventive personalized medicine; Preeclampsia; Pregnancy-associated plasma protein A.