Reviewing Accuracy of First Trimester Screening for Preeclampsia Using Maternal Factors and Biomarkers

Abstract

Preeclampsia is a common and important complication of pregnancy, one with potentially significant morbidity and even mortality to both mother and baby. Identifying those at high risk of developing the condition is helpful as there is evidence that the incidence of preeclampsia can be reduced with low dose aspirin taken in pregnancy. Accurately predicting the risk of preeclampsia allows for more targeted aspirin prophylaxis and a greater opportunity for early detection of maternal and/or fetal complications associated with impaired placentation through a schedule of enhanced antenatal surveillance. Traditional preeclampsia prediction models use maternal characteristics and risk factors and have been shown to be of low predictive value. Multiparametric screening tests combine patient characteristics with serum biomarkers and ultrasound Doppler indices and have been shown to be more effective at detecting those at high risk of preeclampsia - more specifically, early-onset preeclampsia (onset of preeclampsia <34 weeks' gestation). Multiparametric screening has now been validated in different populations. The true cost effectiveness of a multiparametric screening model for preeclampsia screening is not yet fully known and will vary depending on the clinical setting. Despite the growing body of evidence for its improved detection rates, first trimester preeclampsia screening using multiparametric models is not widely implemented and is not part of the recommendations for antenatal screening from most international bodies. The International Federation of Gynecology and Obstetrics has advised universal preeclampsia screening using maternal risk factors and biomarkers and has strongly encouraged its promotion worldwide. Various barriers to implementation must be considered such as the immediate cost of equipment and training, the need for audit and quality control, and the expected benefit to the population. Low to middle income settings may require a pragmatic approach to the implementation of multiparametric screening given limited resources.

Keywords: first trimester; hypertensive disorders of pregnancy; preeclampsia; screening; serum biomarkers; ultrasound.

Figure 1

Screening performance of the first trimester FMF prediction model for preeclampsia according to the different combinations at FPR of 10%. Reproduced with permission from Chaemsaithong P, Sahota DS, Poon LC. First trimester preeclampsia screening and prediction. American journal of obstetrics and gynecology. Feb 2022;226(2S):S1071-S1097 e2, Copyright 2022, with permission from Elsevier.