OP15.03: Maternal cardiovascular hemodynamics for the prediction of pre‐eclampsia at 12–16 weeks

To assess the screening performance of maternal cardiovascular hemodynamic parameters at 12–16 weeks of gestation in combination with the first trimester Fetal Medicine Foundation (FMF) triple test, including maternal factors (MF), mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI) and placental growth factor (PlGF) for preterm pre-eclampsia (PE) and any onset PE. This was a prospective case-control study involving singleton pregnancies screened high-risk (≥1:100) and matched low-risk (< 1:100) for development of preterm PE following the FMF triple test with the ratio of 1:1. Echocardiography was performed at 12–16 weeks to assess maternal cardiovascular hemodynamic parameters (heart rate (HR), stroke volume (SV), cardiac output (CO) and systemic vascular resistance (SVR). Maternal cardiovascular hemodynamic parameters were expressed as multiple of the median (MoM) values determined by multivariable regression of maternal factors. The screening performance for preterm and any onset PE was determined by area under receiver operating characteristic curves (AUC). A total of 743 cases were analysed, with 39 (5.2%) cases that subsequently developed PE including 29 (3.9%) cases of preterm PE. Mean log10 SVR MoM was significantly higher and mean log10 SV MoM and log10 CO MoM were significantly lower in preterm PE group (p < 0.001) and any onset PE group (p < 0.001) than that of unaffected pregnancies. For predicting preterm PE or any onset PE, adding CO or SVR or replacing MAP by CO and SVR in the triple test: MF + MAP + UtA-PI + PlGF achieved higher AUCs than the screening by the FMF triple test. However, the difference of AUCs did not reach statistical significance. Women who develop PE tend to have increased SVR and decreased SV and CO at 12–16 weeks compared to those who do not develop PE. However, adding hemodynamic parameters to the FMF triple test does not enhance its screening performance for PE.