Key result
FMF screening algorithm detects 80% of preterm pre-eclampsia cases in a South Asian cohort.
Why the study?
The performance of the Fetal Medicine Foundation preterm preeclampsia screening algorithm in an indigenous South Asian population was not well evaluated.
Does the Fetal Medicine Foundation algorithm accurately screen for preterm preeclampsia in indigenous South Asian women?
Cohort (n=1,863)
No
Does the Fetal Medicine Foundation algorithm accurately screen for preterm preeclampsia in indigenous South Asian women?
Effect estimate: AUC 0.96 (95% CI 0.95-0.98)
Absolute Event Rate: 80% vs 40%
The FMF preterm preeclampsia screening algorithm performs satisfactorily in South Asian women but requires adjustment of biophysical and biochemical markers for this specific population.
Supports FMF algorithm performance in South Asian women; extends validation but leaves open need for population-specific marker adjustment.
BACKGROUND: To evaluate the performance of the Fetal Medicine Foundation (FMF) preterm preeclampsia (PE) screening algorithm in an indigenous South Asian population. METHODS: This was a prospective observational cohort study conducted in a tertiary maternal fetal unit in Delhi, India over 2 years. The study population comprised of 1863 women carrying a singleton pregnancy and of South Asian ethnicity who were screened for preterm pre-eclampsia (PE) between 11 and 14 weeks of gestation using Mean Arterial Pressure (MAP), transvaginal Mean Uterine Artery Pulsatility Index (UtAPI) and biochemical markers - Pregnancy Associated Plasma Protein-A (PAPP-A) and Placental Growth Factor.. Absolutemeasurements of noted biomarkers were converted to multiples of the expected gestational median (MoMS) which were then used to estimate risk for preterm PE < 37 weeks using Astraia software. Women with preterm PE risk of ≥1:100 was classified as as high risk. Detection rates (DR) at 10% false positive rate were calculated after adjusting for prophylactic aspirin use (either 75 or 150 mg). RESULTS: The incidence of PE and preterm PE were 3.17% (59/1863) and 1.34% (25/1863) respectively. PAPP-A and PlGF MoM distribution medians were 0.86 and 0.87 MoM and significantly deviated from 1 MoM. 431 (23.1%) women had a risk of ≥1:100, 75 (17.8%) of who received aspirin. Unadjusted DR using ≥1:100 threshold was 76%.Estimated DRs for a fixed 10% FPR ranged from 52.5 to 80% depending on biomarker combination after recentering MoMs and adjusting for aspirin use. CONCLUSION: The FMF algorithm whilst performing satisfactorily could still be further improved to ensure that biophysical and biochemical markers are correctly adjusted for indigenous South Asian women.
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Prasad et al. (2021) conducted a cohort in Preterm pre-eclampsia (n=1,863). Fetal Medicine Foundation (FMF) preterm preeclampsia screening algorithm vs. Maternal history alone was evaluated on Detection rate of preterm pre-eclampsia at a 10% false positive rate using maternal history plus four biomarkers (MAP, UtAPI, PlGF, PAPP-A) (AUC 0.96, 95% CI 0.95-0.98). The Fetal Medicine Foundation screening algorithm using maternal history and four biomarkers achieved an 80% detection rate for preterm pre-eclampsia at a 10% false positive rate (AUC 0.96) in an indigenous South Asian population.
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