Extended first-trimester screening (EFTS) for detecting aneuploidy and predicting preeclampsia

A new study evaluated the effectiveness of extended first-trimester screening (EFTS) in the early detection and management of preeclampsia.

This study enrolled a cohort of 501 parturients aged 18-49, with a gestational age (GA) of 11-13 weeks, who underwent the EFTS quadruple test. This investigation encompassed various parameters, including age, sonographic data (CRL, Nuchal Tube (NT), ductus venosus PI), and biochemical tests (b-hCG, Alpha-fetoprotein, PLGF, and PAPP-A for Trisomy 21, 18, and 13). All participants were monitored for the development of preeclampsia. The predictive role of independent and combined EFTS predictors in forecasting preeclampsia was evaluated using independent samples’ t’- and Fisher exact tests. ROC analysis was conducted for continuous predictors significantly associated with the risk of preeclampsia. 

The mean age of the participants was 28.07±4.77 years. The quadruple test yielded negative results in 84.2% of the cases. Positive test results emerged for Down’s syndrome/T21 in 4.6% of cases, T21 with increased PLGF in 1.6%, and increased PLGF in 9.6% of cases. Preeclampsia developed in 14 (2.8%) women. Older age, T21 risk, PLGF risk, and any abnormality in the quadruple test were significantly associated with preeclampsia (p<0.05). On ROC analysis, age had the highest area under the curve value for predicting preeclampsia, with maximum sensitivity and specificity. Overall, the quadruple test demonstrated 71.4% sensitivity and 85.8% specificity in predicting preeclampsia.

The results concluded that EFTS is a valuable strategy in significantly reducing preeclampsia incidence. The findings underscore the importance of age as a robust predictor of preeclampsia among women screened with EFTS, emphasizing the need for tailored management approaches for pregnancies in advanced age.

Source:Anjani A, Rai G, Sharma GV, Rajouraya S, Chaudhary SK. Indian J ObstetGynecol Res 2023 Nov;10(4):445-450