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Serum screening with Down's syndrome markers to predict pre-eclampsia and small for gestational age: systematic review and meta-analysis.

Morris RK, Cnossen JS, Langejans M, Robson SC, Kleijnen J, Ter Riet G, Mol BW, van der Post JA, Khan KS - BMC Pregnancy Childbirth (2008)

Bottom Line: Two authors independently extracted data on study characteristics, quality and results.The results showed low predictive accuracy overall.A potential clinical application using aspirin as a treatment is given as an example.There were methodological and reporting limitations in the included studies thus studies were heterogeneous giving pooled results with wide confidence intervals.

View Article: PubMed Central - HTML - PubMed

Affiliation: Academic Department of Obstetrics and Gynaecology, University of Birmingham, Birmingham Women's Hospital, Birmingham, B15 2TG, UK. r.k.morris@bham.ac.uk

ABSTRACT

Background: Reliable antenatal identification of pre-eclampsia and small for gestational age is crucial to judicious allocation of monitoring resources and use of preventative treatment with the prospect of improving maternal/perinatal outcome. The purpose of this systematic review was to determine the accuracy of five serum analytes used in Down's serum screening for prediction of pre-eclampsia and/or small for gestational age.

Methods: The data sources included Medline, Embase, Cochrane library, Medion (inception to February 2007), hand searching of relevant journals, reference list checking of included articles, contact with experts. Two reviewers independently selected the articles in which the accuracy of an analyte used in Downs's serum screening before the 25th gestational week was associated with the occurrence of pre-eclampsia and/or small for gestational age without language restrictions. Two authors independently extracted data on study characteristics, quality and results.

Results: Five serum screening markers were evaluated. 44 studies, testing 169,637 pregnant women (4376 pre-eclampsia cases) and 86 studies, testing 382,005 women (20,339 fetal growth restriction cases) met the selection criteria. The results showed low predictive accuracy overall. For pre-eclampsia the best predictor was inhibin A>2.79MoM positive likelihood ratio 19.52 (8.33,45.79) and negative likelihood ratio 0.30 (0.13,0.68) (single study). For small for gestational age it was AFP>2.0MoM to predict birth weight < 10th centile with birth < 37 weeks positive likelihood ratio 27.96 (8.02,97.48) and negative likelihood ratio 0.78 (0.55,1.11) (single study). A potential clinical application using aspirin as a treatment is given as an example.There were methodological and reporting limitations in the included studies thus studies were heterogeneous giving pooled results with wide confidence intervals.

Conclusion: Down's serum screening analytes have low predictive accuracy for pre-eclampsia and small for gestational age. They may be a useful means of risk assessment or of use in prediction when combined with other tests.

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Related in: MedlinePlus

Forest Plot showing likelihood ratio of a positive and negative test result with 95% confidence intervals (95% CI) for studies of Inhibin A to predict pre-eclampsia and small for gestational age (birth weight threshold as indicated). Results with diamonds are pooled results (number of studies as indicated), results with squares are single studies. The number of women included in the studies is shown. (a first trimester testing).
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Figure 7: Forest Plot showing likelihood ratio of a positive and negative test result with 95% confidence intervals (95% CI) for studies of Inhibin A to predict pre-eclampsia and small for gestational age (birth weight threshold as indicated). Results with diamonds are pooled results (number of studies as indicated), results with squares are single studies. The number of women included in the studies is shown. (a first trimester testing).

Mentions: The results for inhibin A are summarized in Figure 7. For PET there were 6 included studies, 1 performed in the first trimester, the commonest threshold being inhibin A>2.0MoM (2 studies) with a LR+ 6.00 (5.12,7.03), LR- 0.72 (0.48,1.09). The most accurate predictor for PET was inhibin A>2.79MoM; LR+ 19.52 (8.33,45.79), LR- 0.30 (0.13,0.68), however this result was derived from one study using a receiver operating characteristic curve to determine threshold.


Serum screening with Down's syndrome markers to predict pre-eclampsia and small for gestational age: systematic review and meta-analysis.

Morris RK, Cnossen JS, Langejans M, Robson SC, Kleijnen J, Ter Riet G, Mol BW, van der Post JA, Khan KS - BMC Pregnancy Childbirth (2008)

Forest Plot showing likelihood ratio of a positive and negative test result with 95% confidence intervals (95% CI) for studies of Inhibin A to predict pre-eclampsia and small for gestational age (birth weight threshold as indicated). Results with diamonds are pooled results (number of studies as indicated), results with squares are single studies. The number of women included in the studies is shown. (a first trimester testing).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2533288&req=5

Figure 7: Forest Plot showing likelihood ratio of a positive and negative test result with 95% confidence intervals (95% CI) for studies of Inhibin A to predict pre-eclampsia and small for gestational age (birth weight threshold as indicated). Results with diamonds are pooled results (number of studies as indicated), results with squares are single studies. The number of women included in the studies is shown. (a first trimester testing).
Mentions: The results for inhibin A are summarized in Figure 7. For PET there were 6 included studies, 1 performed in the first trimester, the commonest threshold being inhibin A>2.0MoM (2 studies) with a LR+ 6.00 (5.12,7.03), LR- 0.72 (0.48,1.09). The most accurate predictor for PET was inhibin A>2.79MoM; LR+ 19.52 (8.33,45.79), LR- 0.30 (0.13,0.68), however this result was derived from one study using a receiver operating characteristic curve to determine threshold.

Bottom Line: Two authors independently extracted data on study characteristics, quality and results.The results showed low predictive accuracy overall.A potential clinical application using aspirin as a treatment is given as an example.There were methodological and reporting limitations in the included studies thus studies were heterogeneous giving pooled results with wide confidence intervals.

View Article: PubMed Central - HTML - PubMed

Affiliation: Academic Department of Obstetrics and Gynaecology, University of Birmingham, Birmingham Women's Hospital, Birmingham, B15 2TG, UK. r.k.morris@bham.ac.uk

ABSTRACT

Background: Reliable antenatal identification of pre-eclampsia and small for gestational age is crucial to judicious allocation of monitoring resources and use of preventative treatment with the prospect of improving maternal/perinatal outcome. The purpose of this systematic review was to determine the accuracy of five serum analytes used in Down's serum screening for prediction of pre-eclampsia and/or small for gestational age.

Methods: The data sources included Medline, Embase, Cochrane library, Medion (inception to February 2007), hand searching of relevant journals, reference list checking of included articles, contact with experts. Two reviewers independently selected the articles in which the accuracy of an analyte used in Downs's serum screening before the 25th gestational week was associated with the occurrence of pre-eclampsia and/or small for gestational age without language restrictions. Two authors independently extracted data on study characteristics, quality and results.

Results: Five serum screening markers were evaluated. 44 studies, testing 169,637 pregnant women (4376 pre-eclampsia cases) and 86 studies, testing 382,005 women (20,339 fetal growth restriction cases) met the selection criteria. The results showed low predictive accuracy overall. For pre-eclampsia the best predictor was inhibin A>2.79MoM positive likelihood ratio 19.52 (8.33,45.79) and negative likelihood ratio 0.30 (0.13,0.68) (single study). For small for gestational age it was AFP>2.0MoM to predict birth weight < 10th centile with birth < 37 weeks positive likelihood ratio 27.96 (8.02,97.48) and negative likelihood ratio 0.78 (0.55,1.11) (single study). A potential clinical application using aspirin as a treatment is given as an example.There were methodological and reporting limitations in the included studies thus studies were heterogeneous giving pooled results with wide confidence intervals.

Conclusion: Down's serum screening analytes have low predictive accuracy for pre-eclampsia and small for gestational age. They may be a useful means of risk assessment or of use in prediction when combined with other tests.

Show MeSH
Related in: MedlinePlus