Prediction of Recurrent Preeclampsia Using First-Trimester Uterine Artery Doppler

OBJECTIVE: To evaluate the role of first-trimester uterine artery Doppler in the prediction of recurrent preeclampsia (PE). METHODS: Uterine artery pulsatility index (UtPI) was measured at 11 to 13 weeks' gestation in 1,810 women with singleton pregnancies who had developed PE in a previous pregnancy. They were categorized into three subgroups according to UtPI multiple of median (MoM): < 1.0, 1.0 to 1.49, and ≥ 1.50 MoM. The rate of early onset PE (< 34 weeks), intermediate PE (34 to 36 weeks), late PE (≥ 37 weeks), perinatal death, and small-for-gestational-age outcome (SGA; below the 5th percentile) were compared between each subgroup. RESULTS: The median mean UtPI decreased with advancing crown-rump length (CRL) from 1.77 at CRL of 45 to 54 mm to 1.52 at CRL of 75 to 84 mm. UtPI < 1.0 MoM was associated with a low-risk of early PE (0.2%), intermediate PE (0.3%), perinatal death (0.3%), and SGA (3.3%). The risk for these complications increases with UtPI of 1.0 to 1.4 MoM or ≥ 1.5 MoM (early PE 2.8 and 14.3%, respectively, p < 0.001; intermediate PE 2.1 and 5.4%, p < 0.001; perinatal death 1.3 and 6.8%, p < 0.001; and SGA 8.0 and 20.9%, p < 0.001). CONCLUSION: In women with previous PE, first-trimester UtPI discriminates women at high and low risk for recurrence of PE and adverse pregnancy outcomes.