Predictive Value Of Serum PLGF,UtA-PI,and MAP In The First And Second Trimesters Of Pregnancy For Preeclampsia

Background and objectivepreeclampsia(PE)is a pregnancy-specific disease characterized by hypertension and multiple organ damage after 20 weeks of pregnancy.At present,the global incidence of preeclampsia is about 2%-8%,and its pathogenesis is complex.With the continuous progress of the disease,without regular monitoring and active treatment,it can lead to eclampsia,HELLP syndrome,placental abruption and other serious complications.Clinically,preeclampsia is not only the main cause of maternal and infant death,but also increases the risk of long-term maternal and fetal cardiovascular diseases.At present,the etiology and pathogenesis of preeclampsia are not completely clear,and further in-depth research is still needed,and there is a lack of effective prevention and treatment measures.Early prediction and active treatment are of great significance to reduce maternal and infant mortality.According to studies,the complexity and uncertainty of etiology and pathogenesis make single clinical indicators unable to predict preeclampsia well.A large number of studies have shown that the combination of multiple indicators in early pregnancy can effectively predict preeclampsia.At present,the prediction model of preeclampsia is mainly based on early pregnancy serum markers,uterine artery pulsatility index(UtA-PI)and mean arterial pressure(MAP).Studies have shown that the second trimester of pregnancy also has predictive value for preeclampsia through related models.Relatively few studies have been conducted to predict preeclampsia in both the first and second trimesters.In this study,the levels of serum PLGF,UtA-PI and MAP in the first and second trimester of pregnancy were detected to explore the predictive value of the three indicators alone and in combination for preeclampsia,hoping to provide ideas and references for clinical prediction of preeclampsia.Materials and methods(1)Research object:In this study,pregnant women who received antenatal examination in the obstetrics clinic of Taizhou People’s Hospital of Jiangsu Province from November 2021 to July2022 were selected as research objects to track the pregnancy outcome.According to the exclusion criteria,a total of 57 pregnant women meeting the diagnostic criteria for preeclampsia were in the case group and 164 normal pregnant women were in the control group.Age,gestational age,and BMI in the first and second trimesters were similar between the case and control groups.The diagnostic criteria for preeclampsia are based on the Guidelines for the Diagnosis and Treatment of Hypertensive Disorders during Pregnancy(2020).(2)Research method:A prospective nested case-control study was conducted.The general information of the two groups of pregnant women was recorded,and the serum PLGF,bilateral uterine artery PI,and blood pressure of both arms were measured at the first(11-13+ 6 weeks)and second trimester(20-24+6 weeks)of pregnancy.The corrected multiple of median(MOM)of PLGF,UtA-PI and MAP were calculated by Lucina software.SPSS26.0 was used for statistical analysis,and the differences of each index between the two groups were compared.ROC curves of single index and combined index in the first and second trimester of pregnancy were drawn and AUC was calculated to further study the predictive value of single index and combination of multiple indicators for preeclampsia.The optimal Cut-off value,sensitivity and specificity were calculated by ROC curve.This study has been approved by the Ethics committee of our hospital.All subjects voluntarily signed the informed consent form,ethics number KY 2021-059-01.Results(1)In the first trimester,the serum PLGF MOM value of the case group was significantly lower than that of the control group(0.94±0.16 vs 1.09±0.18),and the difference was statistically significant(P < 0.001).The UtA-PI MOM and MAP MOM values of the case group were significantly higher than those of the control group(1.17±0.19 vs 0.98±0.23,1.15±0.13 vs 1.05±0.11),and the differences were statistically significant(P < 0.001).(2)In the first trimester,the AUC of PLGF,UtA-PI and MAP were 0.754,0.737 and 0.728,respectively.(3)In the first trimester,the AUC of the combination of PLGF+UtA-PI,PLGF+MAP and UtA-PI+MAP for predicting preeclampsia were 0.834,0.814 and 0.802, respectively.The AUC of the combination of the three indicators for predicting preeclampsia was 0.869.(4)In the second trimester of pregnancy,the serum PLGF MOM value of the case group was significantly lower than that of the control group(0.81±0.16 vs 0.96±0.21),the difference was statistically significant(P < 0.001).The UtA-PI MOM and MAP MOM values of the case group were significantly higher than those of the control group(1.18±0.23 vs 0.99±0.23,1.15±0.17 vs 1.06±0.15),and the differences were statistically significant(P < 0.001).(5)In the second trimester,the AUC of PLGF,UtA-PI and MAP were 0.746,0.724 and 0.713,respectively.(6)In the second trimester,the AUC of the combination of PLGF+UtA-PI, PLGF+MAP and UtA-PI+MAP were 0.801,0.783 and 0.778,respectively,and the AUC of the combination of the three indicators was 0.828.Conclusions(1)Compared with normal pregnant women,the serum PLGF of preeclampsia patients in the first trimester was significantly lower,while UtA-PI and MAP were significantly higher.(2)Serum PLGF,UtA-PI and MAP in the first trimester had certain predictive value for preeclampsia.The accuracy of the combination of two indicators is higher than that of any single indicator,and the accuracy of the combination of three indicators is the highest.(3)Compared with normal pregnant women,PLGF was significantly decreased,while UtA-PI and MAP were significantly increased in preeclampsia patients during the second trimester.(4)Serum PLGF,UtA-PI and MAP in the second trimester had certain predictive value for preeclampsia.The accuracy of the combination of two indicators is higher than that of any single indicator,and the accuracy of the combination of three indicators is the highest.