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The following article is a publication describing research funded by the Health Technology Assessment programme under project number 12/25/03, which has been published in a third-party journal. This page provides the citation and link to the article. For information about copyright and reproduction of the original publication, please see the publisher's website.
Citation
Duhig KE, Seed PT, Placzek A, Sparkes J, Hendy E, Gill C, et al. Prognostic indicators of severe disease in late preterm pre-eclampsia to guide decision making on timing of delivery: the PEACOCK study. Pregnancy Hypertens 2021;24:90–95. https://doi.org/10.1016/j.preghy.2021.02.012
Abstract
Objective
To assess the diagnostic performance of angiogenic biomarkers in determining need for delivery in seven days in women with late preterm preeclampsia.
Study design
In a prospective observational cohort study in 36 maternity units across England and Wales, we studied the diagnostic accuracy of placental growth factor (PlGF) and sFlt-1 in determining the risk of complications requiring delivery in late preterm (34+0 to 36+6 weeks' gestation) preeclampsia. Angiogenic biomarkers were measured using the Quidel (PlGF) and Roche (sFlt-1:PlGF ratio) assays. Additional clinical data was obtained for use within the established ‘Prediction of complications in early-onset pre-eclampsia’ (PREP)-S prognostic model. Biomarkers were assessed using standard methods (sensitivity, specificity, Receiver Operator Curve areas). Estimated probability of early delivery from PREP-S was compared to actual event rates.
Main outcome measures
Clinically indicated need for delivery for pre-eclampsia within seven days.
Results
PlGF (Quidel) testing had high sensitivity (97.9%) for delivery within seven days, but negative predictive value was only 71.4%, with low specificity (8.4%), with similar results from sFlt-1/PlGF assay. The area under the curve for PlGF was 0.60 (SE 0.03), and 0.65 (0.03), and 0.64 (0.03) for PREP-S in combination with PlGF, and sFlt-1:PlGF, respectively.
Conclusions
Angiogenic biomarkers do not add to clinical assessment to help determine need for delivery for women with late preterm pre-eclampsia. Existing models developed in women with early-onset pre-eclampsia to predict complications cannot be used to predict clinically indicated need for delivery in women with late preterm pre-eclampsia.
Funding
This publication was funded by Health Technology Assessment programme as a part of project number 12/25/03.