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Prognostic indicators of severe disease in late preterm pre-eclampsia to guide decision making on timing of delivery: The PEACOCK study

Research output: Contribution to journalArticlepeer-review

Kate E Duhig, Paul T Seed, Anna Placzek, Jenie Sparkes, Eleanor Hendy, Carolyn Gill, Anna Brockbank, Andrew H Shennan, Shakila Thangaratinam, Lucy C Chappell

Original languageEnglish
Pages (from-to)90-95
Number of pages6
JournalPregnancy Hypertension
Early online date3 Mar 2021
E-pub ahead of print3 Mar 2021
PublishedJun 2021

Bibliographical note

Funding Information: This research was supported by grants from the National Institute for Health Research, Health Technology Assessment Programme (HTA – 15/59/06) and National Institute for Health Research Professorship (Chappell RP-2014-05-019). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health. PS is funded in part by Tommy’s (registered charity number 1060508) and by the Collaboration for Leadership in Applied Health Research and Care South London (National Institute for Health Research). The funders had no involvement in the study design, collection and analysis of data, data interpretation report writing or the decision to submit the article for publication. Publisher Copyright: © 2021 The Authors Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

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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.

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