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CME Credit Offered
CME Credit Offered
Abstract Award
Abstract Award
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Poster Session 1

(331) Adjustment of UtA-PI for maternal baseline characteristics does not improve predictive performance for preeclampsia

Thursday, January 30, 2025
10:30 AM – 12:30 PM  

    Submitting Author and Presenting Author(s)

  • Rebecca Horgan, MD

    Assistant Professor
    Macon & Joan Brock Virginia Health Sciences Eastern Virginia Medical School at Old Dominion University
    Norfolk, VA, United States

    • Coauthor(s)

  • EK

    Erkan Kalafat, MD, MSc

    Associate Professor
    Koc University Hospital
    Istanbul, Istanbul, Turkey

  • Elena Sinkovskaya, MD, PhD

    Professor
    Macon & Joan Brock Virginia Health Sciences Eastern Virginia Medical School at Old Dominion University
    Norfolk, Virginia, United States

  • Alfred Z. Abuhamad, MD

    President, Provost and Dean
    Macon & Joan Brock Virginia Health Sciences Eastern Virginia Medical School at Old Dominion University
    Norfolk, Virginia, United States

  • George R. Saade, MD (he/him/his)

    Professor and Chair, Associate Dean for Women's Health Obstetrics and Gynecology
    Macon & Joan Brock Virginia Health Sciences Eastern Virginia Medical School at Old Dominion University
    Norfolk, Virginia, United States

Objective: The evidence regarding first trimester uterine artery (UtA) Doppler as a predictor of preeclampsia (PE) is contradictory. UtA perfusion is sensitive to various factors which were not considered previously. Our objective was to determine whether first trimester UtA Doppler measurements, adjusted for maternal baseline characteristics, predict PE.

Study Design: This was a prospective cohort study which enrolled patients at ≤ 13+6 weeks’ gestation. Patients were followed throughout pregnancy and data obtained by trained research coordinators. At the 1st trimester study visit, UtA Doppler pulsatility index (UtA-PI) was obtained. Generalized Additive Models for Location, Scale and Shape were used for modelling UtA-PI, which was found to have distributional properties fitting gamma distribution. Predictive capabilities of raw and maternal characteristics adjusted multiple of median UtA-PI values were tested with area-under the curve values and concordance index. The primary outcome was PE and complicated PE defined as placental abruption, delivery < 34 weeks or HELLP syndrome.

Results: 571 pregnant patients without chronic hypertension were included in the study. Regression analyses showed increasing gestational age at measurement (P=0.03) and increasing maternal age (P=0.003) were both associated with lower UtA-PI values. There were no associations with body-mass index (P=0.36), race (P=0.7), mean arterial pressure (P=0.25) and parity (P=0.4). UtA-PI had poor predictive performance for PE, and there was no improvement after adjusting for gestational age and maternal age (AUC: 0.567 vs. 0.570, P=0.56, Concordance index: 0.582±0.04 vs. 0.583±0.04, P=0.98). UtA-PI was a strong predictor of complicated PE, and there was no improvement following adjustment (AUC: 0.871 vs. 0.858, P=0.56, Concordance index: 0.866±0.03 vs. 0.848±0.03, P=0.65).

Conclusion: UtA-PI is a strong predictor of complicated preeclampsia but not overall preeclampsia. Adjustment of UtA-PI for maternal baseline characteristics does not improve predictive performance.