早孕期联合母体危险因素和平均动脉压预测子痫前期的效能评估OACSTPCD

Objective:To evaluate the efficacy of the Fetal Medicine Foundation(FMF)algorithm in predicting preeclampsia in a local population by combining maternal fac-tors and mean arterial pressure.Methods:Baseline clinical data were collected from pregnant women who underwent NT ultrasound(11～13+6 weeks of gestation)or hospitalized in the Northern Theater General Hospital from August 2021 to the end of December 2021.Calculate mean arterial pressure(MAP)at NT,Calculate the risk value using the publicly available free preeclampsia risk calculator on the FMF website.The pregnancy outcomes were categorized ac-cording to whether or not they had preeclampsia into the no disease group,early-onset pre-eclampsia group,late-onset preeclampsia group,preterm-type preeclampsia group,full-term-type preeclampsia group,and all preeclampsia group.Statistical methods were used to compare the differences in baseline information between the groups.The ROC curves were plotted,and the sensitivity of the model for preeclampsia and its different subtypes was calculated at fixed false-positive rates of 5%,10%,15%,and 20%,respectively.The predictive efficacy of the model was evaluated by comparing the results with the actual observations and the screening results recommended by the《Guidelines for the Diagnosis and Treatment of Hypertensive Diseases in Pregnancy(2020)》and the《ACOG guidelines(2018)》in China.Results:A total of 1847 pregnancies were included in this study for analysis.A total of 112(6.1%)developed pre-eclampsia,including 29(1.6%)pregnant women with early-onset preeclampsia,83(4.4%)pregnant women with late-onset preeclampsia,35(1.9%)pregnant women with preterm-type preeclampsia,and 77(4.1%)pregnant women with full-term-type preeclampsia.Maternal fac-tor+MAP was a better predictor of preeclampsia than single maternal factor,with an area under the ROC curve(AUC)of 0.847,and sensitivities of 45.50%,61.60%,70.50%,and 78.60%at fixed false-positive rates of 5%,10%,15%,and 20%,respectively.The best prediction of preterm preeclampsia was achieved with an AUC of 0.881,and the sensitivities were 51.40%,62.90%,74.30%,and 80.00%at a fixed false positive rate of 5%,10%,15%,and 20%,re-spectively.The sensitivity of predicting preeclampsia according to China's"Guidelines for the diagnosis and treatment of hypertensive disorders in pregnancy(2020)"and ACOG guidelines(2018)was 8.04%(9/112)and 56.25%(63/112),respectively.In the same population,the sensitivity of combined maternal factors and MAP in all preeclampsia and preterm preeclampsia was 77.68%(87/112)and 85.71%(30/35),respectively.Its prediction of preeclampsia was significantly higher than that of major guidelines.Conclusion:The FMF competing risk model combined with maternal factors and MAP has better predictive efficacy for the prevalence of preeclampsia in the local population,and has the best predictive efficacy for preterm preeclamp-sia,which is better than the single maternal factor and the major guidelines.The combination of maternal factors and MAP can be chosen to predict preeclampsia in resource-poor areas or hos-pitals.