Prediction of pre‐eclampsia by uterine artery Doppler ultrasonography and maternal serum pregnancy‐associated plasma protein‐A, free β‐human chorionic gonadotropin, activin A and inhibin A at 22 + 0 to 24 + 6 weeks' gestation

Abstract

To investigate the potential value of combining uterine artery Doppler ultrasonography with the measurement of maternal serum pregnancy‐associated plasma protein‐A (PAPP‐A), free β‐human chorionic gonadotropin (β‐hCG), activin A and inhibin A at 22 + 0 to 24 + 6 weeks' gestation, in the prediction of pregnancies that subsequently develop pre‐eclampsia. The maternal serum PAPP‐A, free β‐hCG, activin A and inhibin A concentrations at 22 + 0 to 24 + 6 weeks' gestation were measured in samples obtained from women with singleton pregnancies who participated in a screening study for pre‐eclampsia by transvaginal color flow Doppler measurement of the uterine artery pulsatility index (PI). A search was made of the database to identify those who subsequently developed pre‐eclampsia (n = 24) and a group of controls with normal outcome (n = 144). Regression analysis was performed to establish any relationship between the biochemical markers themselves and between the biochemical markers and uterine artery mean PI. A multivariate Gaussian model combining various biochemical markers with uterine artery mean PI was developed using standard statistical modeling techniques and the performance of such models in discriminating cases with pre‐eclampsia was evaluated by receiver–operating characteristics curve (ROC) analysis. In the pre‐eclampsia group, compared to the controls, the uterine artery mean PI and the maternal serum levels of PAPP‐A, free β‐hCG, activin A and inhibin A were significantly increased. The predicted detection rates of pre‐eclampsia, for a false positive rate of 5%, was 50% by uterine artery mean PI, 5% by PAPP‐A, 10% by free β‐hCG, 35% by inhibin A and 44% by activin A. Screening by a combination of uterine artery mean PI and maternal serum activin A and inhibin A could detect 75% and 92% of patients who subsequently developed pre‐eclampsia, for false positive rates of 5% and 10%, respectively. Screening for pre‐eclampsia by uterine artery PI at 22 + 0 to 24 + 6 weeks' gestation can be improved by measurement of activin A and inhibin A levels. Copyright © 2006 ISUOG. Published by John Wiley & Sons, Ltd.