Combined albumin-adjusted ischemia-modified albumin ratio and uterine artery Doppler for differentiating early-onset preeclampsia from gestational hypertension: a prospective exploratory pilot study

Distinguishing early-onset preeclampsia (EO-PE) from gestational hypertension (GHT) at initial presentation remains challenging, particularly when classical diagnostic features are absent or evolving. We evaluated whether combining the albumin-adjusted ischemia-modified albumin ratio (IMAR) with uterine artery pulsatility index expressed as multiples of the median (UtA-PI MoM) provides complementary information in this setting. In this prospective single-center exploratory study, 90 singleton pregnancies (30 EO-PE, 30 GHT, 30 controls) were included. IMAR and UtA-PI MoM were assessed individually and in combination using receiver operating characteristic analysis and logistic regression with bootstrap internal validation. IMAR and UtA-PI MoM were higher in EO-PE than in GHT ( p = 0.003 and p < 0.001, respectively), whereas raw IMA did not distinguish the groups. IMAR demonstrated moderate discrimination (AUC 0.727, 95% CI 0.600–0.854), and UtA-PI MoM demonstrated higher performance (AUC 0.844, 95% CI 0.743–0.946). The combined model showed the highest apparent discrimination (AUC 0.898, 95% CI 0.818–0.977; optimism-corrected AUC 0.889), with 83.3% sensitivity and 86.7% specificity at the exploratory operating point. Combining IMAR with UtA-PI MoM may provide complementary information for distinguishing EO-PE from GHT at initial presentation. This exploratory model is not intended to replace established angiogenic biomarkers and requires validation in larger, multicenter studies before clinical application.