{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T23:36:30Z","timestamp":1791848190375,"version":"4.3.4"},"reference-count":23,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2021,9,13]],"date-time":"2021-09-13T00:00:00Z","timestamp":1631491200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To compare the screening performance of serum pregnancy\u2010associated plasma protein\u2010A (PAPP\u2010A) <jats:italic>vs<\/jats:italic> placental growth factor (PlGF) in routine first\u2010trimester combined screening for pre\u2010eclampsia (PE), small\u2010for\u2010gestational age (SGA) at birth and trisomy 21.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective study nested in pregnancy cohorts undergoing first\u2010trimester combined screening for PE and trisomy 21 using The Fetal Medicine Foundation (FMF) algorithm based on maternal characteristics, nuchal translucency thickness, PAPP\u2010A, free beta\u2010human chorionic gonadotropin, blood pressure and uterine artery Doppler. Women at high risk for preterm PE (\u2265\u20091 in 50) received 150\u2009mg of aspirin per\u00a0day, underwent serial fetal growth scans at 28 and 36\u2009weeks and were offered elective birth from 40\u2009weeks of gestation. PlGF was quantified retrospectively from stored surplus first\u2010trimester serum samples. The performance of combined first\u2010trimester screening for PE and SGA using maternal history, blood pressure, uterine artery pulsatility index and either PAPP\u2010A or PlGF was calculated. Similarly, the performance of combined first\u2010trimester screening for trisomy 21 was calculated using either PAPP\u2010A or PlGF in addition to maternal age, nuchal translucency thickness and free beta\u2010human chorionic gonadotropin.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Maternal serum PAPP\u2010A was assayed in 1094 women, including 82 with PE, 111 with SGA (birth weight\u00a0&lt;\u200910<jats:sup>th<\/jats:sup> centile), 53 with both PE and SGA and 94 with fetal trisomy 21. PlGF levels were obtained retrospectively from 1066\/1094 women. Median serum PlGF multiples of the median was significantly lower in pregnancies with PE (1.0 (interquartile range (IQR), 0.8\u20131.4); <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.01), SGA (1.0 (IQR, 0.8\u20131.3); <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) and trisomy 21 (0.6 (IQR, 0.5\u20130.9); <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.0001) compared to in controls (1.2 (IQR, 0.9\u20131.5)). There was no significant difference in the performance of first\u2010trimester screening using PAPP\u2010A <jats:italic>vs<\/jats:italic> PlGF for either preterm PE (area under the receiver\u2010operating\u2010characteristics curve (AUC), 0.78 <jats:italic>vs<\/jats:italic> 0.79; <jats:italic>P\u2009=<\/jats:italic>\u20090.55) or term PE (AUC, 0.74 <jats:italic>vs<\/jats:italic> 0.74; <jats:italic>P<\/jats:italic>\u2009=\u20090.60). These findings persisted even after correction for the effect of targeted aspirin use on the prevalence of PE. Similarly, there were no significant differences in sensitivity and specificity of combined screening for SGA or trisomy 21 when using PAPP\u2010A <jats:italic>vs<\/jats:italic> PlGF.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Using either PlGF or PAPP\u2010A in routine first\u2010trimester combined screening based on maternal characteristics, blood pressure and uterine artery Doppler does not make a significant clinical difference to the detection of PE or SGA. Depending on the setting, biomarkers should be chosen to achieve a good compromise between performance and measurement requirements. This pragmatic clinical\u2010effectiveness study suggests that combined screening for PE can be implemented successfully in a public healthcare setting without changing current protocols for the assessment of PAPP\u2010A in the first trimester. \u00a9 2021 The Authors. <jats:italic>Ultrasound in Obstetrics &amp; Gynecology<\/jats:italic> published by John Wiley &amp; Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.23669","type":"journal-article","created":{"date-parts":[[2021,5,17]],"date-time":"2021-05-17T06:14:01Z","timestamp":1621232041000},"page":"540-545","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Routine\u2009first\u2010trimester\u2009combined\u2009screening for pre\u2010eclampsia: pregnancy\u2010associated plasma <scp>protein\u2010A<\/scp> or placental growth factor?"],"prefix":"10.1002","volume":"58","author":[{"given":"L.","family":"No\u00ebl","sequence":"first","affiliation":[{"name":"Fetal Medicine Unit St George's University Hospitals NHS Foundation Trust, University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. P.","family":"Guy","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit Medway NHS Foundation Trust  Gillingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Jones","sequence":"additional","affiliation":[{"name":"Prenatal Screening Unit King George's Hospital, Barking, Havering and Redbridge University Hospitals NHS Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Forenc","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit St George's University Hospitals NHS Foundation Trust, University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Buck","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit St George's University Hospitals NHS Foundation Trust, University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. T.","family":"Papageorghiou","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit St George's University Hospitals NHS Foundation Trust, University of London  London UK"},{"name":"Vascular Biology Research Centre Molecular and Clinical Sciences Research Institute, St George's University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.","family":"Thilaganathan","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit St George's University Hospitals NHS Foundation Trust, University of London  London UK"},{"name":"Vascular Biology Research Centre Molecular and Clinical Sciences Research Institute, St George's University of London  London UK"},{"name":"Tommy's National Centre for Maternity Improvement Royal College of Obstetricians and Gynaecologists  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,9,13]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.18816"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1704559"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.16361"},{"key":"e_1_2_8_5_1","unstructured":"National Institute for Health and Care Excellence(2019).Antenatal care for uncomplicated pregnancies. 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