The Value Of Serum Screening Markers For Down Syndrome In The Prediction Of Preeclampsia

Objective:To investigate the value of the pregnancy related plasma protein A(PAPP-A),alpha fetoprotein(AFP)and free?-Human chorionic gonadotropin(?-hCG)in the prediction of preeclampsia.Methods:The pregnant women who received Down syndrome screening in The first affiliated hospital of Soochow University from October 2015 to August 2016 were included in the study.All pregnant women were screened for Down syndrome at early gestation(11~13+6weeks)and during the second trimester(15~20+6 weeks).The automatic time resolved fluorescence immunoassay system and its kit were used to detect serum markers such as PAPP-A,free?-hCG in early pregnancy and AFP,free?-hCG in the middle trimester.Maternal general data were collected and follow-up results for each maternal pregnancy were followed up.SPSS19.0 statistical software was used to analyze the data.Results:1.Finally,there were 1870 pregnant women with singleton pregnancy enrolled in the study.All the subjects were divided into two groups.51 cases of pregnant women with preeclampsia is preeclampsia group,and 1819 cases of normal pregnant women is control group.The incidence of preeclampsia in this study was 2.73%.2.The weight,BMI,MAP in early pregnancy and the MAP at admission were higher in the preeclampsia group than that in the control group,and the differences were statistically significant(P<0.05).In the preeclampsia group,the proportion of primipara,IVF and chronic hypertensive women was higher than that of the control group,and the differences were statistically significant(P<0.05).3.The gestational age and birth weight of the neonates in the preeclampsia group were smaller than those in the control group,and the differences were statistically significant(P<0.05).The proportion of placental abruption and premature delivery in preeclampsia group was higher than that in control group,and the difference was statistically significant(P<0.05).4.The early pregnancy serum PAPP-A concentration in the preeclampsia group was lower than that in the control group,and the differences were statistically significant(P<0.05).5.The early pregnancy PAPP-A levels,BMI and MAP were used as the test variables to construct the regression prediction model,and draw the ROC curve.The area under each curve is 0.622,0.659,and 0.671,the predictive values are 2984.546mU/L,26.005kg/m~2and 89.835mmHg.6.The best screening model for predicting preeclampsia in this study was BMI+MAP+PAPP-A+Primipara+IVF+chronic hypertension history.O n the basis of this model,the area under the ROC curve is 0.766,P=0.000.When the best cut-off value was0.033,the maximum Youden index was 0.458,the sensitivity was 64.7%and specificity was 81.1%.Conclusions:1.In the serological index of Down syndrome screening,early pregnancy PAPP-A has a certain predictive value for preeclampsia,but the correlation between AFP and?-hCG and preeclampsia remains to be further studied.2.The predictive value of BMI+MAP+PAPP-A+Primipara+IVF+chronic hypertension history screening models was the highest in preeclampsia,which was better than single factor.However,excessive biochemical markers may not significantly increase the predictive value of preeclampsia,but will increase the economic burden of pregnant women.And for all pregnant women,it is very important to inquire in detail about medical histories in the first trimester.