Abstract
Background: Preeclampsia and related placental-mediated disorders contribute substantially to maternal and perinatal morbidity. First-trimester multimarker screening combines maternal characteristics with biophysical and biochemical markers to estimate risk before clinical disease becomes apparent. Objective: To describe maternal and perinatal outcomes in a cohort undergoing first-trimester multimarker screening and to evaluate the association and predictive performance of selected screening markers for adverse pregnancy outcomes. Methods: This prospective cohort study enrolled 108 women with singleton pregnancies at 11+0 to 13+6 weeks of gestation in a tertiary care teaching hospital. Maternal characteristics, mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI), placental growth factor (PlGF), pregnancy-associated plasma protein-A (PAPP-A), and soluble fms-like tyrosine kinase-1 (sFlt-1) were recorded. Participants were followed until delivery. Maternal and perinatal outcomes were summarised, and the predictive performance of individual markers and a combined model was assessed. Results: Seventeen women (15.7%) were classified as high risk by the reported combined screening model. Twenty-six women (24.1%) developed a hypertensive disorder of pregnancy, including nine with gestational hypertension, seven with preeclampsia without severe features, four with preeclampsia with severe features, two with HELLP syndrome, one with placental abruption, and one with eclampsia; outcome categories may have overlapped. Preterm birth occurred in 21 pregnancies (19.4%), low birth weight in 19 (17.6%), and neonatal intensive care unit admission in 13 (12.0%). The submitted dataset reported an area under the receiver operating characteristic curve of 0.931 for the combined model. Conclusion: First-trimester multimarker assessment was feasible in this single-centre cohort and identified a subgroup with a higher frequency of adverse outcomes. However, the predictive estimates require verification against the original patient-level dataset, prespecified outcome definitions, and an adequately powered validation cohort.
Keywords: First-trimester screening; Preeclampsia; Placental growth factor; Pregnancy-associated plasma protein-A; Uterine artery Doppler; Mean arterial pressure; placental dysfunction.