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Am J Perinatol 2019; 36(09): 930-935
DOI: 10.1055/s-0038-1675209
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

First-Trimester Uterine Artery Doppler for the Prediction of Preeclampsia in Nulliparous Women: The Great Obstetrical Syndrome Study

Suzanne Demers
1   Department of Gynecology, Obstetrics and Reproduction, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
2   Reproduction, Mother and Child Health Unit, CHU de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
,
Amélie Boutin
2   Reproduction, Mother and Child Health Unit, CHU de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
,
Cédric Gasse
2   Reproduction, Mother and Child Health Unit, CHU de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
3   Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
,
Olivier Drouin
1   Department of Gynecology, Obstetrics and Reproduction, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
,
Mario Girard
2   Reproduction, Mother and Child Health Unit, CHU de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
,
Emmanuel Bujold
1   Department of Gynecology, Obstetrics and Reproduction, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
2   Reproduction, Mother and Child Health Unit, CHU de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
› Author Affiliations
Funding This project was funded by the Jeanne-et-Jean-Louis-Lévesque perinatal research Chair at Université Laval and by the Jean-Louis-Lévesque Foundation, Montreal, Quebec, Canada. Dr Emmanuel Bujold holds a Clinician-Scientist Award from the Fonds de recherche du Québec–Santé (FRQ-S).
Further Information

Publication History

13 November 2017

12 September 2018

Publication Date:
10 November 2018 (online)

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Abstract

Objective This study aimed to estimate the performance of first-trimester uterine artery (UtA) pulsatility index (PI) for the prediction of preeclampsia (PE).

Study Design We conducted a prospective cohort study of nulliparous women with singleton gestation at 11 to 13 6/7 weeks. UtA-Doppler's was performed on both UtAs and the mean UtA-PI was reported in multiple of median (MoM) adjusted for gestational age. Using receiver operating characteristic curves and their area under the curves (AUC); we calculated the performance of UtA-PI for the prediction of PE. Proportional hazard models were used to develop prediction models combining UtA-PI and maternal characteristics.

Results Out of 4,676 participants with completed follow-up, 232 (4.9%) developed PE, including 202 (4.3%) term and 30 (0.6%) preterm PE. Mean UtA-PI decreased with gestational age between 11 and 13 6/7 weeks (p < 0.001). First-trimester UtA-PI was associated with preterm (AUC: 0.69; 95% CI [confidence interval]: 0.57–0.80) but not with term (AUC: 0.52; 95% CI: 0.48–0.56) PE. UtA-PI combined with maternal characteristics could predict 45% of preterm PE at a false positive rate of 10%.

Conclusion First-trimester UtA-PI decreases with gestational age between 11 and 13 6/7 weeks and is associated with the risk of preterm but not term PE.

Keywords

pregnancy - preeclampsia - ultrasound - Doppler's - antenatal screening