Abstract
Objective The aim of this study was to develop a multiparameter risk-based scoring system for
first-trimester prediction of preeclampsia and to validate this scoring system in
our patient population.
Study Design Secondary analysis of a prospective cohort of 1,200 patients presenting for first-trimester
aneuploidy screening. Maternal serum pregnancy-associated plasma protein A (PAPP-A)
levels were measured and bilateral uterine artery (UA) Doppler studies performed.
Using the first half of the study population, a prediction model for preeclampsia
was created. Test performance characteristics were used to determine the optimal score
for predicting preeclampsia. This model was then validated in the second half of the
population.
Results Significant risk factors and their weighted scores derived from the prediction model
were chronic hypertension (4), history of preeclampsia (3), pregestational diabetes
(2), body mass index ≥ 30 kg/m2 (2), bilateral UA notching (1), and PAPP-A MoM < 10th percentile (1). The area under
the curve (AUC) for the risk scoring system was 0.76 (95% confidence interval [CI],
0.69–0.83), and the optimal threshold for predicting preeclampsia was a total score
of ≥ 6. This AUC did not differ significantly from the AUC observed in our validation
cohort (AUC, 0.78 [95% CI, 0.69–0.86]; p = 0.75].
Conclusion Our proposed risk factor scoring system demonstrates modest accuracy but excellent
reproducibility for first-trimester prediction of preeclampsia.
Keywords
aneuploidy screening - first-trimester prediction - hypertension in pregnancy - pregnancy-associated
plasma protein A - preeclampsia - uterine artery Doppler
