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Meta-Analysis
. 2015 Aug 25:15:191.
doi: 10.1186/s12884-015-0608-y.

Serum screening in first trimester to predict pre-eclampsia, small for gestational age and preterm delivery: systematic review and meta-analysis

Yan Zhong  1 , Fufan Zhu  2 , Yiling Ding  3
Affiliations
Meta-Analysis

Serum screening in first trimester to predict pre-eclampsia, small for gestational age and preterm delivery: systematic review and meta-analysis

Yan Zhong et al. BMC Pregnancy Childbirth. .

Abstract

Background: Early assessment before the establishment of placental dysfunction has the potential to improve treatment and prognosis for clinical practice.The objective of the study is to investigate the accuracy of serum biochemical markers(Pregnancy- Associated Plasma Protein-A (PAPP-A), human Chorionic Gonadotropin (hCG), Placental Growth Factor (PlGF), Placental Protein 13 (PP13) used in first trimester serum screening in predicting preelampsia, small for gestational age (SGA) and preterm delivery.

Methods: The data sources included Medline, Embase, Cochrane library, Medion, hand searching of relevant journals, reference list checking of included articles and contact with experts. Two reviewers independently selected the articles. Two authors independently extracted data on study characteristics, quality and results.

Results: The results showed low predictive accuracy overall. For preeclampsia, the best predictor was PlGF; LR + 4.01 (3.74, 4.28), LR-(0.67, 0.64, 0.69). The predictive value of serum markers for early preeclampsia was better than that of late preeclampsia. For SGA the best predictor was PP13; LR+ 3.70 (3.39, 4.03), LR- 0.70 (0.67, 0.73). For preterm delivery, the best predictor was PP13; LR+ 4.16 (2.72, 5.61), LR- 0.56 (0.45, 0.67).

Conclusion: First trimester screening analytes have low predictive accuracy for pre-eclampsia, small for gestational age and preterm delivery. However, the predict value of first trimester analytes is not worse than that of the second trimester markers.

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Figures

Fig. 1
Fig. 1
Seletion process: process from initial search to final inclusion for biochemical screening to predict pre-eclampsia/small for gestational age/preterm delievery
Fig. 2
Fig. 2
Study quality: bar chart showing quality of evidence on first trimester biochemical screening markers to predict pre-eclampsia, small for gestational age and preterm delivery
Fig. 3
Fig. 3
Forest plot for PAPP-A to predict preeclampsia: forest plot showing likelihood ratio of a positive and negative test result with 95 % confidence intervals (95 % CI) for studies of Pregnancy- Associated Plasma Protein-A (PAPP-A) to predict pre-eclampsia. * continuous: Likelihood ratio calculated from receiver operating curve analysis
Fig. 4
Fig. 4
Forest plot for PAPP-A to predict SGA: forest Plot showing likelihood ratio of a positive and negative test result with 95 % confidence intervals (95 % CI) for studies of Pregnancy- Associated Plasma Protein-A (PAPP-A) to predict small for gestational age (SGA). * continuous: Likelihood ratio calculated from receiver operating curve analysis
Fig. 5
Fig. 5
Forest plot for PAPP-A to predict preterm delivery: forest Plot showing likelihood ratio of a positive and negative test result with 95 % confidence intervals (95 % CI) for studies of Pregnancy- Associated Plasma Protein-A (PAPP-A) to predict preterm delivery. * continuous: Likelihood ratio calculated from receiver operating curve analysis
Fig. 6
Fig. 6
Forest plot for PP13 to predict preeclampsia, SGA and preterm delivery: forest Plot showing likelihood ratio of a positive and negative test result with 95 % confidence intervals (95 % CI) for studies of Placental Protein 13 (PP13) to predict preeclampsia, small for gestational age (SGA) and preterm delivery. * continuous: Likelihood ratio calculated from receiver operating curve analysis
Fig. 7
Fig. 7
Forest plot for PlGF to predict preeclampsia, SGA and preterm delivery: forest Plot showing likelihood ratio of a positive and negative test result with 95 % confidence intervals (95 % CI) for studies of Placental Growth Factor (PlGF) to predict preeclampsia, small for gestational age (SGA) and preterm delivery. * continous: Likelihood ratio calculated from receiver operating curve analysis
Fig. 8
Fig. 8
Forest plot for hCG to predict preeclampsia: forest Plot showing likelihood ratio of a positive and negative test result with 95 % confidence intervals (95 % CI) for studies of Human chorionic gonadotrophin (hCG) to predict preeclampsia. * continuous: Likelihood ratio calculated from receiver operating curve analysis
Fig. 9
Fig. 9
Forest plot for hCG to predict SGA: forest Plot showing likelihood ratio of a positive and negative test result with 95 % confidence intervals (95 % CI) for studies of Human chorionic gonadotrophin (hCG) to predict small for gestational age (SGA). * continuous: Likelihood ratio calculated from receiver operating curve analysis
Fig. 10
Fig. 10
Forest plot for hCG to predict prelivery: forest Plot showing likelihood ratio of a positive and negative test result with 95 % confidence intervals (95 % CI) for studies of Human chorionic gonadotrophin (hCG) to predict preterm delivery
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