Cohort Study: First-trimester screening protocol achieves higher detection rates for preterm preeclampsia in nulliparous women – Hypertension

This study aimed to evaluate the effectiveness of the Fetal Medicine Foundation’s (FMF) first-trimester screening protocol for predicting preterm preeclampsia in nulliparous women. A prospective multicenter cohort study was conducted involving 7554 nulliparous women, recruited at 11 to 14 weeks of pregnancy. Screening included assessing maternal characteristics, mean arterial blood pressure, pregnancy-associated plasma protein A (PAPP-A), placental growth factor (PlGF), and uterine artery pulsatility index. The risk assessment was performed by a third party, blinded to pregnancy outcomes, using receiver operating characteristic curves. Of the participants, 7325 remained eligible beyond 20 weeks of gestation. Among these, 65 (0.9%) developed preterm preeclampsia and 22 (0.3%) early-onset preeclampsia. The FMF screening test achieved a detection rate of 63.1% for preterm and 77.3% for early-onset preeclampsia at a false-positive rate of 15.8%. In comparison, using criteria from the American College of Obstetricians and Gynecologists, the detection rates were 61.5% and 59.1%, respectively, but at a higher false-positive rate of 34.3%. The findings suggest that the FMF screening test is a more accurate and efficient method for predicting preterm preeclampsia in the first trimester among nulliparous women.

Reference (link to abstract – $ for full-text):

Paul Guerby et al. (2024). Prospective Validation of First-Trimester Screening for Preterm Preeclampsia in Nulliparous Women (PREDICTION Study). Hypertension. DOI: 10.1161/HYPERTENSIONAHA.123.22584