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. 2008 Aug;199(2):122.e1-122.e11.
doi: 10.1016/j.ajog.2008.01.013. Epub 2008 Jun 9.

First-trimester maternal serum PP13 in the risk assessment for preeclampsia

Roberto Romero  1 , Juan Pedro Kusanovic, Nandor Gabor Than, Offer Erez, Francesca Gotsch, Jimmy Espinoza, Samuel Edwin, Ilana Chefetz, Ricardo Gomez, Jyh Kae Nien, Marei Sammar, Beth Pineles, Sonia S Hassan, Hamutal Meiri, Yossi Tal, Ido Kuhnreich, Zoltan Papp, Howard S Cuckle
Affiliations

First-trimester maternal serum PP13 in the risk assessment for preeclampsia

Roberto Romero et al. Am J Obstet Gynecol. 2008 Aug.

Abstract

Objective: The objective of the study was to determine whether first-trimester maternal serum placental protein 13 (PP13) concentrations can be used in the risk assessment for preeclampsia.

Study design: This case-control study included 50 patients with preeclampsia and 250 patients with normal pregnancies. Samples were collected between 8 and 13 weeks of gestation. Serum PP13 concentrations were measured by immunoassay and expressed as medians and multiples of the median (MoM) for gestational age. Sensitivity and specificity were derived from receiver-operating characteristic curve analysis.

Results: (1) Serum PP13 concentration in the first trimester was significantly lower in patients who developed preterm and early-onset preeclampsia than in those with normal pregnancies; and (2) at 80% specificity, a cutoff of 0.39 MoM had a sensitivity of 100% for early-onset preeclampsia and 85% for preterm preeclampsia.

Conclusion: Maternal serum first-trimester PP13 appears to be a reasonable marker for risk assessment for preterm preeclampsia but a weak marker for severe preeclampsia at term, and ineffective for identifying mild preeclampsia at term.

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Figures

Figure 1
Figure 1. PP13 multiples of the median (MoMs) according to the study groups
The results are based on the first model where PP13 MoM was adjusted to GA and BMI. The boxplot represents the medians (as a horizontal line within the box), the 25th and 75th quartiles and the maximum and minimum for each group. Red dots refer to outliers in the right position, the filled red dot refers to a clipped outlier outside the range of the figure. PE: preeclampsia.
Figure 2
Figure 2. Receiver operating characteristic (ROC) curve depicting the sensitivity and specificity of PP13 MoM in maternal serum for the identification of all cases of preeclampsia
The results are based on the second model where PP13 MoM was adjusted to GA, BMI, maternal age and parity.
Figure 3
Figure 3. Receiver operating characteristic (ROC) curves depicting the sensitivity and specificity of first trimester maternal serum PP13 MoM for the identification of the different clinical subtypes of preeclampsia
A: ROC curves were generated based on the first model where PP13 MoM was adjusted to GA and BMI. PE = preeclampsia. The diagnostic indices that were generated from these curves are presented in Table IVA. B: ROC curves were generated based on the second model where PP13 MoM was adjusted to GA,BMI, maternal age, and parity. PE = preeclampsia. The diagnostic indices that were generated from these curves are presented in Table IVB.
Figure 3
Figure 3. Receiver operating characteristic (ROC) curves depicting the sensitivity and specificity of first trimester maternal serum PP13 MoM for the identification of the different clinical subtypes of preeclampsia
A: ROC curves were generated based on the first model where PP13 MoM was adjusted to GA and BMI. PE = preeclampsia. The diagnostic indices that were generated from these curves are presented in Table IVA. B: ROC curves were generated based on the second model where PP13 MoM was adjusted to GA,BMI, maternal age, and parity. PE = preeclampsia. The diagnostic indices that were generated from these curves are presented in Table IVB.
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References

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