Prediction of pre-eclampsia and its subtypes in high-risk cohort : hyperglycosylated human chorionic gonadotropin in multivariate models

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Murtoniemi , K , Villa , P M , Matomäki , J , Keikkala , E , Vuorela , P , Hämäläinen , E , Kajantie , E , Pesonen , A-K , Räikkönen , K , Taipale , P , Stenman , U-H & Laivuori , H 2018 , ' Prediction of pre-eclampsia and its subtypes in high-risk cohort : hyperglycosylated human chorionic gonadotropin in multivariate models ' , BMC Pregnancy and Childbirth , vol. 18 , 279 . https://doi.org/10.1186/s12884-018-1908-9

Title: Prediction of pre-eclampsia and its subtypes in high-risk cohort : hyperglycosylated human chorionic gonadotropin in multivariate models
Author: Murtoniemi, Katja; Villa, Pia M.; Matomäki, Jaakko; Keikkala, Elina; Vuorela, Piia; Hämäläinen, Esa; Kajantie, Eero; Pesonen, Anu-Katriina; Räikkönen, Katri; Taipale, Pekka; Stenman, Ulf-Håkan; Laivuori, Hannele
Other contributor: University of Helsinki, Medicum
University of Helsinki, Department of Obstetrics and Gynecology
University of Helsinki, Clinicum
University of Helsinki, HUSLAB
University of Helsinki, Lastentautien yksikkö
University of Helsinki, Medicum
University of Helsinki, Medicum
University of Helsinki, Medicum
University of Helsinki, Institute for Molecular Medicine Finland














Date: 2018-07-03
Language: eng
Number of pages: 10
Belongs to series: BMC Pregnancy and Childbirth
ISSN: 1471-2393
DOI: https://doi.org/10.1186/s12884-018-1908-9
URI: http://hdl.handle.net/10138/237277
Abstract: Background: The proportion of hyperglycosylated human chorionic gonadotropin (hCG-h) to total human chorionic gonadotropin (%hCG-h) during the first trimester is a promising biomarker for prediction of early-onset pre-eclampsia. We wanted to evaluate the performance of clinical risk factors, mean arterial pressure (MAP), %hCG-h, hCG beta, pregnancy-associated plasma protein A (PAPP-A), placental growth factor (PIGF) and mean pulsatility index of the uterine artery (Uta-PI) in the first trimester in predicting pre-eclampsia (PE) and its subtypes early-onset, late-onset, severe and non-severe PE in a high-risk cohort. Methods: We studied a subcohort of 257 high-risk women in the prospectively collected Prediction and Prevention of Pre-eclampsia and Intrauterine Growth Restriction (PREDO) cohort Multivariate logistic regression was used to construct the prediction models. The first model included background variables and MAP. Additionally, biomarkers were included in the second model and mean Uta-PI was included in the third model. All variables that improved the model fit were included at each step. The area under the curve (AUC) was determined for all models. Results: We found that lower levels of serum PIGF concentration were associated with early-onset PE, whereas lower %hCG-h was associated with the late-onset PE. Serum PIGF was lower and hCG beta higher in severe PE, while %hCG-h and serum PAPP-A were lower in non-severe PE. By using multivariate regression analyses the best prediction for all PE was achieved with the third model: AUC was 0.66, and sensitivity 36% at 90% specificity. Third model also gave the highest prediction accuracy for late-onset, severe and non-severe PE: AUC 0.66 with 32% sensitivity, AUC 0.65, 24% sensitivity and AUC 0.60, 22% sensitivity at 90% specificity, respectively. The best prediction for early-onset PE was achieved using the second model: AUC 0.68 and 20% sensitivity at 90% specificity. Conclusions: Although the multivariate models did not meet the requirements to be clinically useful screening tools, our results indicate that the biomarker profile in women with risk factors for PE is different according to the subtype of PE. The heterogeneous nature of PE results in difficulty to find new, clinically useful biomarkers for prediction of PE in early pregnancy in high-risk cohorts.
Subject: Pre-eclampsia
Screening
Biomarkers
Early-onset pre-eclampsia
Late-onset pre-eclampsia
Severe pre-eclampsia
Placental growth factor
hCG beta
Hyperglycosylated human chorionic gonadotropin
Pregnancy associated plasma protein a
LOW-DOSE ASPIRIN
TROPHOBLAST INVASION
ONSET PREECLAMPSIA
ANGIOGENIC FACTORS
METAANALYSIS
PREVENTION
PREGNANCIES
REGRESSION
GESTATION
MARKER
3123 Gynaecology and paediatrics
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