Rebecca Allen

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.

Effect of diet- and lifestyle-based metabolic risk-modifying interventions on preeclampsia: a meta-analysis.

To evaluate the effect of dietary and lifestyle interventions with the potential to modify metabolic risk factors on the risk of preeclampsia.

Predictive accuracy of second‐trimester uterine artery Doppler indices for stillbirth: a systematic review and meta‐analysis

To assess the predictive accuracy for stillbirth of second‐trimester uterine artery Doppler.

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.