medigraphic.com
Federación Mexicana de Ginecología y Obstetricia, A.C.

2021, Number 04

<< Back Next >>

Ginecol Obstet Mex 2021; 89 (04)

Predictive model for pregnancyinduced hypertension in mexican women

Acosta-Alfaro LF, Ramos-Martínez MA, Osuna-Ramírez I, Galaviz-Hernández C, Sosa-Macías M, González-Ibarra FP, Murillo-Llanes J

Language: English
References: 30
Page: 299-308
PDF size: 253.89 Kb.


ABSTRACT

Objective: To develop a predictive model for the calculation of specific risk factors per patient, for pregnancy-induced hypertension.
Materials and Methods: We carried out a prospective cohort study of pregnant women admitted during the first trimester. The variables measured were mean arterial pressure, body mass index, mean uterine-artery pulsatility index, placental growth factor, and pregnancy-associated plasma protein A, converted to multiples of the median (MoM). Maternal variables like age, previous preeclampsia and nulliparity were also evaluated through multiple regression analysis, specific predictive models of preeclampsia and gestational hypertension risks were created using the software BRAHMS Fast Screen Pre I plus, version 3.0.0.6, risk calculation version PE 1.0.
Results: A total of 132 patients were included in the study, mean age was 26.5 ± 6.6 years old, with a minimum and maximum age of 15 and 43; in 13 patients (9.9%) there was an elevated high risk for preeclampsia, in the remaining 119 (90.2%) patients, the risk was low. From the patients who developed preeclampsia near term (n = 10), high risk was predicted in2 of 3 patients (66.7%) with severity criteria; and for 1 of 7 patients (14.3%) who developed preeclampsia without severity criteria. The only case with early preeclampsia was found to be at high risk, as well as for 2 among 8 (25%) patients with late preeclampsia. The sensitivity of the predictive model for early preeclampsia was 100% with 90.4% specificity, and a LR+ of 10.4.
Conclusion: The predictive model is of little use in the Mexican population with multiple risk factors for preeclampsia and gestational hypertension.


REFERENCES

  1. Davison JM, Homuth V, Jeyabalan A, Conrad KP, Karumanchi SA, Quaggin S, et al. New Aspects in the Pathophysiology of Preeclampsia. J Am Soc Nephrol. 2004;15(9):2440–2448 doi. 10.1097/01.ASN.0000135975.90889.60.

  2. Roberts JM, Cooper DW. Pathogenesis and genetics of preeclampsia. Lancet. 2001;357(9249):53–56. doi. 10.1016/ s0140-6736(00)03577-7.

  3. Thadhani R, Mutter WP, Wolf M, Levine RJ, Taylor RN, Sukhatme VP, et al. First Trimester Placental Growth Fac tor and Soluble Fms-Like Tyrosine Kinase 1 and Risk for Preeclampsia. J Clin Endocrinol Metab. 2004;89(2):770– 775. doi. 10.1210/jc.2003-031244.

  4. Parra-Cordero M, Rodrigo R, Barja P, Bosco C, Rencoret G, Sepúlveda Martinez A, et al. Prediction of early and late pre-eclampsia from maternal characteristics, uterine artery Doppler and markers of vasculogenesis during first trimester of pregnancy. Ultrasound Obstet Gynecol. 2013;41(5):538-544. doi. 10.1002/uog.12264.

  5. Kuc S, Koster MPH, Franx A, Schielen PCJI, Visser GHA. Maternal Characteristics, Mean Arterial Pressure and Serum Markers in Early Prediction of Preeclampsia. PLOS ONE. 2013;8(5):e63546. . doi:10.1371/journal.pone.0063546.

  6. Poon LC, Kametas NA, Maiz N, Akolekar R, Nicolaides KH. First-trimester prediction of hypertensive disorders in pregnancy. Hypertension. 2009;53(5):812–818. doi: 10.1161/ HYPERTENSIONAHA.108.127977.

  7. Smith GC, Stenhouse EJ, Crossley JA, Aitken DA, Cameron AD, Connor JM. Early pregnancy levels of pregnancy-associated plasma protein a and the risk of intrauterine growth restriction, premature birth, preeclampsia, and stillbirth. J Clin Endocrinol Metab. 2002 Apr;87(4):1762-1767. doi: 10.1210/jcem.87.4.8430.

  8. Ong S, Lash G, Baker PN. Angiogenesis and placental growth in normal and compromised pregnancies. Best Pract Res Clin Obstet Gynaecol. 2000;14(6):969–980. doi: 10.1053/ beog.2000.0138.

  9. Wright D, Syngelaki A, Bradbury I, Akolekar R, & Nicolaides K H. First-Trimester Screening for Trisomies 21, 18 and 13 by Ultrasound and Biochemical Testing. Fetal Diagn Ther.2014;35(2):118–126. doi: 10.1159/000357430.

  10. Cooper JC, Sharkey AM, Charnock-Jones DS, Palmer CR, Smith SK. VEGF mRNA levels in placentae from pregnancies complicated by pre-eclampsia. Br J Obstet Gynaecol. 1996;103(12):1191–1196. doi. 10.1111/j.1471-0528.1996. tb09627.x.

  11. Kim S-Y, Ryu H-M, Yang J-H, Kim M-Y, Han J-Y, Kim J-O, et al. Increased sFlt-1 to PlGF ratio in women who subsequently develop preeclampsia. J Korean Med Sci. 2007;22(5):873- 877. doi. 10.3346/jkms.2007.22.5.873.

  12. Akolekar R, Syngelaki A, Sarquis R, Zvanca M, Nicolaides KH. Prediction of early, intermediate and late pre-eclampsia from maternal factors, biophysical and biochemical markers at 11-13 weeks. Prenat Diagn. 2011;31(1):66–74. doi. 10.1002/pd.2660.

  13. Vandenberghe G, Mensink I, Twisk JWR, Blankenstein MA, Heijboer AC, van Vugt JMG. First trimester screening for intra-uterine growth restriction and early-onset pre-eclampsia. Prenat Diagn. 2011;31(10):955–961. doi. 10.1002/pd.2807.

  14. Akolekar R, de Cruz J, Foidart J-M, Munaut C, Nicolaides KH. Maternal plasma soluble fms-like tyrosine kinase-1 and free vascular endothelial growth factor at 11 to 13 weeks of gestation in preeclampsia. Prenat Diagn. 2010;30(3):191- 197. doi. 10.1002/pd.2433.

  15. Poon LC, Nicolaides KH. First-trimester maternal factors and biomarker screening for preeclampsia. Prenat Diagn. 2014 Jul;34(7):618-627. doi: 10.1002/pd.4397.

  16. Zhang J, Zeisler J, Hatch MC, Berkowitz G. Epidemiology of pregnancy-induced hypertension. Epidemiol Rev. 1997;19(2):218-32. doi. 10.1093/oxfordjournals.epirev. a017954.

  17. Detección, Diagnóstico y Tratamiento de Enfermedades Hipertensivas del Embarazo. Guía de Evidencias y Recomendaciones: Guía de Práctica Clínica. México, IMSS; 2017 (Spanish).

  18. Salomon LJ, Alfirevic Z, Bilardo CM, Chalouhi GE, Ghi T, Kagan KO, et al.ISUOG Practice Guidelines: performance of first-trimester fetal ultrasound scan. Ultrasound Obstet Gynecol. 2013;41(1):102–113. doi. 10.1002/ uog.12342.

  19. Palacios Y, Latan J, Rivera L, Cabrera Lozada C, Pacheco R, Cabrera Figallo C. Relación entre la presión arterial media y el desarrollo de preeclampsia. Rev Latin Perinat. 2018; 21 (1): 37- 41.

  20. Thermo Fisher Scientific Inc [Internet].Waltham (MA):c2020. PIGF Plus; Dec 12[cited 2021 Jan 15]. https:// www.brahms.de/products/prenatal-screening/productassays/ plgf-plus. html.

  21. Spencer K. Risk, a QC parameter. DSNEWS 2003, 10(1):30- 31. http://diamedica.lt/uploads/kryptorp_product_sheet_ pns_papp-a_kryptor_en.pdf.

  22. Von Haehling S, Doehner W, Jankowska EA, Ponikowski P, Stellos K, Puntmann VO et al. Value of serum pregnancyassociated plasma protein A for predicting cardiovascular events among patients presenting with cardiac chest pain. CMAJ. 2013;185(7):E295-E303. doi. 10.1503/ cmaj.110647.

  23. Akolekar R, Syngelaki A, Sarquis R, Zvanca M, & Nicolaides KH. Prediction of early, intermediate and late pre-eclampsia from maternal factors, biophysical and biochemical markers at 11-13 weeks. Prenat Diagn. 2011;31(1):66–74. doi. 10.1002/pd.2660.

  24. Spradley FT, Palei AC, Granger JP. Immune Mechanisms Linking Obesity and Preeclampsia. Biomolecules. 2015;5(4):3142–3176. doi. 10.3390/biom5043142.

  25. Lynch AM, Murphy JR, Gibbs RS, Levine RJ, Giclas PC, Salmon JE, Holers VM. The interrelationship of complementactivation fragments and angiogenesis-related factors in early pregnancy and their association with pre-eclampsia. BJOG. 2010;117(4):456-462. doi. 10.1111/j.1471- 0528.2009.02473.x.

  26. Spradley FT. Metabolic abnormalities and obesity’s impact on the risk for developing preeclampsia. Am J Physiol Regul Integr Comp Physiol. 2017; 312(1):R5–R12. doi. 10.1152/ ajpregu.00440.2016.

  27. Rodríguez Ballesteros, Raúl; Neri Ruz, Eduardo.Preeclampsia: ¿es posible su predicción y prevención en la actualidad?Rev Sanid Milit Mex 2017; 71(5): 437-442.

  28. Sibai, B. First-trimester screening with combined maternal clinical factors, biophysical and biomarkers to predict preterm pre-eclampsia and hypertensive disorders: are they ready for clinical use? BJOG. 2015;122(3): 282–283. doi. 10.1111/1471-0528.13052.

  29. Rolnik DL, Wright D, Poon LC, O’Gorman N, Syngelaki A, de Paco Matallana C, Nicolaides KH. Aspirin versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia. N Engl J Med. 2017;377(7): 613–622. doi. 10.1056/NEJMoa1704559.

  30. Allen RE, Zamora J, Arroyo-Manzano D, Velauthar L, Allotey J, Thangaratinam S, Aquilina J. External validation of preexisting first trimester preeclampsia prediction models. Eur J Obstet Gynecol Reprod Biol. 2017; 217: 119-25. doi. 10.1016/j.ejogrb.2017.08.031.




2020     |     www.medigraphic.com