Assessing quality standards of biomarker measurement in first‐trimester combined screening for preeclampsia in the Chinese population: A multicenter study
11 affiliations
- 1Department of Reproductive Center, National Clinical Research Center for Chinese Medicine First Teaching Hospital of Tianjin University of Traditional Chinese Medicine Tianjin China
- 2Department of Obstetrics and Gynaecology Prince of Wales Hospital, The Chinese University of Hong Kong Hong Kong SAR China
- 3Department of Obstetrics Obstetrics and Gynaecology Hospital of Fudan University Shanghai China
- 4Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University Shenzhen Guangdong Province China
- 5Department of Obstetrics and Gynaecology and Reproductive Medicine Peking University First Hospital Beijing China
- 6Department of Obstetrics, Shanghai Key Laboratory of Maternal Fetal Medicine Shanghai Institute of Maternal‐Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University Shanghai China
- 7Department of Obstetrics and Gynaecology West China Second University Hospital, Sichuan University Chengdu China
- 8Key Laboratory of Birth Defects and Related Diseases of Women and Children Sichuan University, Ministry of Education Chengdu Sichuan China
- 9Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region Nanning Guangxi P. R. China
- 10Shenzhen Research Institute, The Chinese University of Hong Kong Hong Kong SAR China
- 11Fetal Medicine Center Tam Anh General Hospital Ho Chi Minh City Vietnam
Abstract
Introduction: The first‐trimester combined screening test for preterm preeclampsia (preterm‐PE) has been implemented in Mainland China. This study aims, first, to evaluate the applicability of multiple of the median (MoM) models based on biomarkers developed and utilized in a European population for prospective preterm‐PE screening in Mainland China; second, to assess the criteria for biomarker adjustment; and third, to establish criteria for continuous quality assurance in the screening process.
Material and Methods: In this prospective multicenter cross‐sectional study, 22 066 singleton pregnancies undergoing preterm‐PE screening at 11 + 0–13 + 6 weeks were recruited from six tertiary hospitals in Mainland China. Mean arterial pressure (MAP) and placental growth factor (PlGF) were measured and converted to their equivalent MoM values using Fetal Medicine Foundation MoMing models incorporated in commercial software. PlGF levels were also determined using immunoassays developed in China. MoM and log10MoM distributions in the initial screened subjects were assessed for (1) central tendency and dispersion and (2) whether biomarker MoM distributions needed to be recentered. Biomarker central tendency and temporal stability both before and after recentering were assessed using Cumulative Sum plots. Distribution central tendency was considered good if its median MoM was between 0.95 and 1.05 and acceptable if between 1.05 and 1.10.
Results: After excluding the initial 400 pregnancies from each center, all PlGF, but not all MAP MoM distributions, required recentering. Post‐recentering, the overall distribution median (95% confidence interval) MoM values for MAP and PlGF were 1.003 (1.001, 1.004) and 1.004 (0.996, 1.013), respectively.
Conclusions: Chinese centers performing combined PE screening should assess biomarker MoM distributions in their initial cases to ensure that they conform to the expected central tendencies assumed in the risk estimation models.
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BibTeX
@article{liu2026assessing,
title = {{Assessing quality standards of biomarker measurement in first‐trimester combined screening for preeclampsia in the Chinese population: A multicenter study}},
author = {Jiao Liu and Xiaotian Li and Huixia Yang and Qiongjie Zhou and Hao Ying and Rong Zhou and Yanping Zhang and Wang Xueyin and Han Xie and Xinzhi Tu and Lin Kong and Jie Qin and Chi Chiu Wang and Xiaohong Lu and Long Nguyen‐Hoang and Daljit S. Sahota and Liona C. Poon},
journal = {Acta Obstetricia et Gynecologica Scandinavica},
year = {2026},
month = jul,
doi = {10.1111/aogs.70319},
url = {https://doi.org/10.1111/aogs.70319},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Assessing quality standards of biomarker measurement in first‐trimester combined screening for preeclampsia in the Chinese population: A multicenter study
AU - Jiao Liu
AU - Xiaotian Li
AU - Huixia Yang
AU - Qiongjie Zhou
AU - Hao Ying
AU - Rong Zhou
AU - Yanping Zhang
AU - Wang Xueyin
AU - Han Xie
AU - Xinzhi Tu
AU - Lin Kong
AU - Jie Qin
AU - Chi Chiu Wang
AU - Xiaohong Lu
AU - Long Nguyen‐Hoang
AU - Daljit S. Sahota
AU - Liona C. Poon
PY - 2026
DA - 2026/07/14
JO - Acta Obstetricia et Gynecologica Scandinavica
DO - 10.1111/aogs.70319
UR - https://doi.org/10.1111/aogs.70319
AB - Introduction: The first‐trimester combined screening test for preterm preeclampsia (preterm‐PE) has been implemented in Mainland China. This study aims, first, to evaluate the applicability of multiple of the median (MoM) models based on biomarkers developed and utilized in a European population for prospective preterm‐PE screening in Mainland China; second, to assess the criteria for biomarker adjustment; and third, to establish criteria for continuous quality assurance in the screening process. Material and Methods: In this prospective multicenter cross‐sectional study, 22 066 singleton pregnancies undergoing preterm‐PE screening at 11 + 0–13 + 6 weeks were recruited from six tertiary hospitals in Mainland China. Mean arterial pressure (MAP) and placental growth factor (PlGF) were measured and converted to their equivalent MoM values using Fetal Medicine Foundation MoMing models incorporated in commercial software. PlGF levels were also determined using immunoassays developed in China. MoM and log10MoM distributions in the initial screened subjects were assessed for (1) central tendency and dispersion and (2) whether biomarker MoM distributions needed to be recentered. Biomarker central tendency and temporal stability both before and after recentering were assessed using Cumulative Sum plots. Distribution central tendency was considered good if its median MoM was between 0.95 and 1.05 and acceptable if between 1.05 and 1.10. Results: After excluding the initial 400 pregnancies from each center, all PlGF, but not all MAP MoM distributions, required recentering. Post‐recentering, the overall distribution median (95% confidence interval) MoM values for MAP and PlGF were 1.003 (1.001, 1.004) and 1.004 (0.996, 1.013), respectively. Conclusions: Chinese centers performing combined PE screening should assess biomarker MoM distributions in their initial cases to ensure that they conform to the expected central tendencies assumed in the risk estimation models.
SN - 0001-6349
SN - 1600-0412
ER -