Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 May;40(6):746-757.
doi: 10.1002/pd.5683. Epub 2020 Apr 7.

Population screening for gestational hypertensive disorders using maternal, fetal and placental characteristics: A population-based prospective cohort study

Jan S Erkamp  1   2 , Vincent W V Jaddoe  1   2 , Liesbeth Duijts  1   3 , Irwin K M Reiss  1   4 , Annemarie G M G J Mulders  5 , Eric A P Steegers  5 , Romy Gaillard  1   2
Affiliations

Population screening for gestational hypertensive disorders using maternal, fetal and placental characteristics: A population-based prospective cohort study

Jan S Erkamp et al. Prenat Diagn. 2020 May.

Abstract

Objective: To determine screening performance of maternal, fetal and placental characteristics for selecting pregnancies at risk of gestational hypertension and preeclampsia in a low-risk multi-ethnic population.

Method: In a prospective population-based cohort among 7124 pregnant women, we collected maternal characteristics including body mass index, ethnicity, parity, smoking and blood pressure in early-pregnancy. Fetal characteristics included second and third trimester estimated fetal weight and sex determined by ultrasound. Placental characteristics included first and second trimester placental growth factor concentrations and second and third trimester uterine artery resistance indices.

Results: Maternal characteristics provided the best screening result for gestational hypertension (area-under-the-curve [AUC] 0.79 [95% Confidence interval {CI} 0.76-0.81]) with 40% sensitivity at 90% specificity. For preeclampsia, the maternal characteristics model led to a screening performance of AUC 0.74 (95% CI 0.70-0.78) with 33% sensitivity at 90% specificity. Addition of second and third trimester placental ultrasound characteristics only improved screening performance for preeclampsia (AUC 0.78 [95% CI 0.75-0.82], with 48% sensitivity at 90% specificity).

Conclusion: Routinely measured maternal characteristics, known at the start of pregnancy, can be used in screening for pregnancies at risk of gestational hypertension or preeclampsia within a low-risk multi-ethnic population. Addition of combined second and third trimester placental ultrasound characteristics only improved screening for preeclampsia.

PubMed Disclaimer

Conflict of interest statement

The authors declare no potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Screening performance for gestational hypertension based on maternal, fetal and placental characteristics. AUC, area under the curve; CI, confidence interval; EFW, estimated fetal weight; PlGF, placental growth factor; UtA‐RI, uterine artery resistance index. Values are AUC (95% CI), Sensitivity at 70%, 80% and 90% specificity. †Maternal characteristics model: maternal age, BMI, ethnicity, parity and smoking; Blood pressure model: Maternal characteristics model and first trimester mean arterial pressure per 10 mmHg. ‡Baseline model: maternal age, BMI, ethnicity, parity and smoking, and first trimester MAP per 10 mmHg; Fetal sex model: Baseline model + fetal sex; second trimester EFW model: Baseline model and second trimester estimated fetal weight <10th percentile; third trimester EFW model: Baseline model and third trimester estimated fetal weight <10th percentile; second and third trimester EFW model: Baseline model, second and third trimester estimated fetal weight <10th percentile. §Baseline model: maternal age, BMI, ethnicity, parity, smoking, and first trimester MAP per 10 mmHg; second trimester UtA‐RI model: Baseline model, second trimester uterine artery resistance index >90th percentile; third trimester UtA‐RI model: Baseline model, third trimester uterine artery resistance index >90th percentile; second and third trimester UtA‐RI model: Baseline model, second and third trimester uterine artery resistance index >90th percentile. First trimester PlGF model: Baseline model, first trimester placental growth factor <10th percentile; second trimester PlGF model: Baseline model, second trimester placental growth factor <10th percentile; first and second trimester PlGF model: Baseline model, first and second trimester placental growth factor <10th percentile
FIGURE 2
FIGURE 2
Screening performance for preeclampsia based on maternal, fetal and placental characteristics. CI, confidence interval; EFW, estimated fetal weight; PlGF, placental growth factor; UC, area under the curve; UtA‐RI, uterine artery resistance index. Values are AUC (95% CI), Sensitivity at 70%, 80% and 90% specificity. †Maternal characteristics model: maternal age, BMI, ethnicity, parity and smoking; Blood pressure model: Maternal characteristics model and first trimester mean arterial pressure per 10 mmHg.‡Baseline model: maternal age, BMI, ethnicity, parity and smoking, and first trimester MAP per 10 mmHg; Fetal sex model: Baseline model + fetal sex; second trimester EFW model: Baseline model and second trimester estimated fetal weight <10th percentile; third trimester EFW model: Baseline model and third trimester estimated fetal weight <10th percentile; second and third trimester EFW model: Baseline model, second and third trimester estimated fetal weight <10th percentile.§Baseline model: maternal age, BMI, ethnicity, parity, smoking, and first trimester MAP per 10 mmHg; second trimester UtA‐RI model: Baseline model, second trimester uterine artery resistance index >90th percentile; third trimester UtA‐RI model: Baseline model, third trimester uterine artery resistance index >90th percentile; second and third trimester UtA‐RI model: Baseline model, second and third trimester uterine artery resistance index >90th percentile. Second and third trimester UtA‐RI model and first trimester PlGF model: second and third trimester UtA‐RI model, first trimester placental growth factor < 10th percentile; second and third trimester UtA‐RI model and second trimester PlGF model: second and third trimester UtA‐RI model, second trimester placental growth factor <10th percentile; second and third trimester UtA‐RI model and first and second trimester PlGF model: second and third trimester UtA‐RI model, first and second trimester placental growth factor < 10th percentile
FIGURE 3
FIGURE 3
Screening performance for secondary outcome early‐onset preeclampsia based on maternal, fetal and placental characteristics. AUC, area under the curve; CI, confidence interval; EFW, estimated fetal weight; PlGF, placental growth factor; UtA‐RI, uterine artery resistance index. Values are AUC (95% CI), Sensitivity at 70%, 80% and 90% specificity. †Maternal characteristics model: maternal age, BMI, ethnicity, parity and smoking; Blood pressure model: Maternal characteristics model and first trimester mean arterial pressure per 10 mmHg. ‡Baseline model: maternal age, BMI, ethnicity, parity and smoking, and first trimester MAP per 10 mmHg; Fetal sex model: Baseline model + fetal sex; second trimester EFW model: Baseline model and second trimester estimated fetal weight <10th percentile; third trimester EFW model: Baseline model and third trimester estimated fetal weight <10th percentile; second and third trimester EFW model: Baseline model, second and third trimester estimated fetal weight <10th percentile.§Baseline model: maternal age, BMI, ethnicity, parity, smoking, and first trimester MAP per 10 mmHg, and third trimester EFW; second trimester UtA‐RI model: Baseline model, second trimester uterine artery resistance index >90th percentile; third trimester UtA‐RI model: Baseline model, third trimester uterine artery resistance index >90th percentile; second and third trimester UtA‐RI model: Baseline model, second and third trimester uterine artery resistance index >90th percentile. First trimester PlGF model: Baseline model, first trimester placental growth factor <10th percentile; second trimester PlGF model: Baseline model, second trimester placental growth factor <10th percentile; first and second trimester PlGF model: Baseline model, first and second trimester placental growth factor <10th percentile
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Hofmeyr GJ, Lawrie TA, Atallah AN, Torloni MR. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database Syst Rev. 2018;10:CD001059. - PMC - PubMed
    1. Khan KS, Wojdyla D, Say L, Gulmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006;367(9516):1066‐1074. - PubMed
    1. WHO . WHO Recommendations for Prevention and Treatment of Pre‐Eclampsia and Eclampsia. 2011. Geneva, Switzerland: WHO Press, World Health Organization. - PubMed
    1. Steegers EA, von Dadelszen P, Duvekot JJ, Pijnenborg R. Pre‐eclampsia. Lancet. 2010;376(9741):631‐644. - PubMed
    1. Practice Bulletin No ACOG. 202: gestational hypertension and preeclampsia. Obstet Gynecol. 2019;133(1):e1–e25. - PubMed

MeSH terms

Substances