First-Trimester Screening for Preeclampsia Using Maternal Factors, Mean Arterial Pressure, and Uterine Artery Doppler

Abstract

Introduction: Preeclampsia prediction models have evolved from risk factors alone to combined biophysical and biochemical markers. First-trimester prediction may enable prophylactic aspirin use.
Methods: Literature review of prospective validation studies of the Fetal Medicine Foundation (FMF) algorithm or equivalent. Inclusion required measurement of maternal history, mean arterial pressure (MAP), uterine artery pulsatility index (UTPI), and serum PlGF. Primary outcome was preterm preeclampsia (<37 weeks).
Results: Twenty-one studies (n=150,000 pregnancies) met criteria. The combined model detected 77% of preterm preeclampsia cases at a 10% false-positive rate. Adding PlGF increased detection by 12% over MAP+UTPI alone. Performance varied by ethnicity and parity.
Discussion: The FMF algorithm is externally validated but requires calibration to local populations. First-trimester screening is cost-effective in high-income settings. Implementation barriers include ultrasound expertise and biomarker availability.
Conclusions: Combined first-trimester screening using maternal factors, MAP, UTPI, and PlGF predicts preterm preeclampsia with good accuracy and should be offered universally where resources permit.