The potential of repeated mean arterial pressure measurements for predicting early‐ and late‐onset pre‐eclampsia in twin pregnancies: Prediction model study

Abstract

AbstractObjectiveTo investigate the contribution of longitudinal mean arterial pressure (MAP) measurement during the first, second, and third trimesters of twin pregnancies to the prediction of pre‐eclampsia.MethodsA retrospective cohort study was conducted on women with twin pregnancies. Historical data between 2019 and 2021 were analyzed, including maternal characteristics and mean artery pressure measurements were obtained at 11–13, 22–24, and 28–33 weeks of gestation. The outcome measures included pre‐eclampsia with delivery <34 and ≥34 weeks of gestation. Models were developed using logistic regression, and predictive performance was evaluated using the area under the curve, detection rate at a given false‐positive rate of 10%, and calibration plots. Internal validation was conducted via bootstrapping.ResultsA total of 943 twin pregnancies, including 36 (3.82%) women who experienced early‐onset pre‐eclampsia and 93 (9.86%) who developed late‐onset pre‐eclampsia, were included in this study. To forecast pre‐eclampsia during the third trimester, the most accurate prediction for early‐onset pre‐eclampsia resulted from a combination of maternal factors and MAP measured during this trimester. The optimal predictive model for late‐onset pre‐eclampsia includes maternal factors and MAP data collected during the second and third trimesters. The areas under the curve were 0.937 (95% confidence interval [CI] 0.894–0.981) and 0.887 (95% CI 0.852–0.921), respectively. The corresponding detection rates were 83.33% (95% CI 66.53%–93.04%) for early‐onset pre‐eclampsia and 68.82% (95% CI 58.26%–77.80%) for late‐onset pre‐eclampsia.ConclusionRepeated measurements of MAP during pregnancy significantly improved the accuracy of late‐onset pre‐eclampsia prediction in twin pregnancies. The integration of longitudinal data into pre‐eclampsia screening may be an effective and valuable strategy.