Joseph Aquilina

First‐trimester uterine artery Doppler and adverse pregnancy outcome: a meta‐analysis involving 55 974 women

To determine the accuracy with which uterine artery Doppler in the first trimester of pregnancy predicts pre‐eclampsia and fetal growth restriction, particularly early‐onset disease.

Abnormal blood biomarkers in early pregnancy are associated with preeclampsia: a meta-analysis.

OBJECTIVE Our aim was to evaluate the strength of association between abnormal levels of first trimester maternal blood biomarkers and the risk of preeclampsia. STUDY DESIGN We searched MEDLINE, EMBASE and Cochrane databases from inception until April 2013. Studies that assessed the association between any abnormal maternal blood biomarker in the first trimester and preeclampsia were included. Two independent reviewers selected studies, extracted data and assessed the quality. Results were summarized as pooled odds ratios with 95% confidence intervals. RESULTS From 1071 citations, we identified 30 studies (65,538 women) for inclusion. Twenty four studies assessed preeclampsia of any onset, 10 studied early onset preeclampsia and seven evaluated late onset preeclampsia (after 34 weeks of gestation). The biomarkers PAPP-A (OR 2.1, 95% CI 1.6, 2.6), PP13 (OR 4.4, 95% CI 2.9, 6.8), sFlt-1 (OR 1.3, 95% CI 2.9, 6.8), pentraxin (OR 5.3, 95% CI 1.9, 15.0) and inhibin-A (OR 3.6, 95% CI 1.7, 7.6) were significantly associated with any preeclampsia. The odds of early onset preeclampsia were significantly increased when the biomarkers PlGF (OR 3.4, 95% CI 1.6, 7.2), PAPP-A (OR 4.8, 95% CI 2.5, 22.5), PP13 (OR 7.5, 95% CI 2.5, 22.5), soluble endoglin (OR 18.5, 95% CI 8.4, 41.0) and inhibin-A (OR 4.1, 95% CI 1.9, 8.8) were abnormal. Two biomarkers, soluble endoglin (OR 2.1, 95% CI 1.9, 2.4) and inhibin-A (OR 1.9, 95% CI 1.4, 2.8) were significantly associated with late onset preeclampsia. CONCLUSION Abnormal maternal blood biomarkers in early pregnancy are significantly associated with preeclampsia, particularly early onset disease.

Uterine artery Doppler in the first trimester as a risk factor for adverse pregnancy outcomes: a meta-analysis involving 55,974 women

To determine the accuracy with which uterine artery Doppler in the first trimester of pregnancy predicts pre‐eclampsia and fetal growth restriction, particularly early‐onset disease.

Prospective observational study to determine the accuracy of first trimester serum biomarkers and uterine artery Dopplers in combination with maternal characteristics and arteriography for the prediction of women at risk of preeclampsia and other adverse pregnancy outcomes

Abstract Objectives: To assess the efficacy of biomarkers, arteriography and uterine artery Dopplers for predicting hypertensive disease of pregnancy, small for gestational age (SGA) and stillbirth. Methods: This was a prospective first-trimester study. Ultrasound was used to assess uterine artery Doppler. Maternal arteriography was performed and serum was taken for the measurement of placental growth factor (PlGF), alpha-fetoprotein (AFP), pregnancy-associated plasma protein (PAPP-A) and beta-human chorionic gonadotrophin levels. Logistic regression with stepwise selection was performed to determine multivariate models. Results: One thousand and forty-five women were left for analysis after exclusions. Fourteen developed preeclampsia, 23 pregnancy induced hypertension, 64 SGA <5th centile, 118 SGA <10th centile and three stillbirth. Systolic blood pressure (SBP) in the aorta (SBPAO) (p = .002) was significantly associated with preeclampsia. Detection rate (DR) was 72% for a false-positive rate (FPR) of 15%, an area under the curve (AUC) of 0.81, 95% CI 0.69–0.93. MAP and maternal weight (p = .001) were significantly associated with PIH. DR 48%, AUC 0.76, 95% CI 0.65–0.86. Low PAPP-A and PlGF were significantly associated with SGA <10th centile (p = .007 and .004, respectively), DR 30%, AUC 0.608, 95% CI 0.54–0.68. SGA <5th centile was significantly associated with low PlGF (p = <.001), DR 57%, AUC 0.73, 95% CI 0.65–0.80. Conclusions: No association was found between first-trimester biomarkers and preeclampsia/PIH. There was a significant association between low PlGF and PAPP-A and SGA.

Maternal clinical predictors of preterm birth in twin pregnancies: A systematic review involving 2,930,958 twin pregnancies

In twin pregnancies, which are at high risk of preterm birth, it is not known if maternal clinical characteristics pose additional risks. We undertook a systematic review to assess the risk of both spontaneous and iatrogenic early (<34 weeks) or late preterm birth (<37 weeks) in twin pregnancies based on maternal clinical predictors. We searched the electronic databases from January 1990 to November 2017 without language restrictions. We included studies on women with monochorionic or dichorionic twin pregnancies that evaluated clinical predictors and preterm births. We reported our findings as odds ratio (OR) with 95% confidence intervals (CI) and pooled the estimates using random-effects meta-analysis for various predictor thresholds. From 12, 473 citations, we included 59 studies (2,930,958 pregnancies). The risks of early preterm birth in twin pregnancies were significantly increased in women with a previous history of preterm birth (OR 2.67, 95% CI 2.16-3.29, I2 = 0%), teenagers (OR 1.81, 95% CI 1.68-1.95, I2 = 0%), BMI > 35 (OR 1.63, 95% CI 1.30-2.05, I2 = 52%), nulliparous (OR 1.51, 95% CI 1.38-1.65, I2 = 73%), non-white vs. white (OR 1.31, 95% CI 1.20-1.43, I2 = 0%), black vs. non-black (OR 1.38, 95% CI 1.07-1.77, I2 = 98%), diabetes (OR 1.73, 95% CI 1.29-2.33, I2 = 0%) and smokers (OR 1.30, 95% CI 1.23-1.37, I2 = 0%). The odds of late preterm birth were also increased in women with history of preterm birth (OR 3.08, 95% CI 2.10-4.51, I2 = 73%), teenagers (OR 1.36, 95% CI 1.18-1.57, I2 = 57%), BMI > 35 (OR 1.18, 95% CI 1.02-1.35, I2 = 46%), nulliparous (OR 1.41, 95% CI 1.23-1.62, I2 = 68%), diabetes (OR 1.44, 95% CI 1.05-1.98, I2 = 55%) and hypertension (OR 1.49, CI 1.20-1.86, I2 = 52%). The additional risks posed by maternal clinical characteristics for early and late preterm birth should be taken into account while counseling and managing women with twin pregnancies.

First-trimester uterine artery Doppler and adverse pregnancy outcome: a meta-analysis involving 55 974 women: UtA Doppler prediction of adverse pregnancy outcome

To determine the accuracy with which uterine artery Doppler in the first trimester of pregnancy predicts pre‐eclampsia and fetal growth restriction, particularly early‐onset disease.