Early adaptation of Fetomaternal Foundation algorithm screening in Indonesia - A 2 years cohort study in West Java.

OBJECTIVE

To evaluate the performance of the Fetomaternal Foundation (FMF) algorithm, incorporating maternal factors, mean arterial pressure (MAP), and uterine artery pulsatility index (UAPI), for early prediction of preeclampsia (PE) in an Indonesian population.

STUDY

DESIGN

This prospective single-centre study was conducted across five primary health centers (PHC) in West Bandung Regency between August 2023 and 2024. A total of 58 pregnant women at 11+0 - 14+0 weeks of gestation were recruited and followed until the development of preeclampsia or delivery. Six participants were excluded due to loss to follow-up, leaving 52 cases for analysis. The previously published FMF algorithm was applied using a risk cut-off of 1:100.

MAIN OUTCOME MEASURES: Screening performance was assessed by sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) for predicting preeclampsia.

RESULTS

Five of 52 women (9.6%) developed preeclampsia. The combined FMF algorithm (maternal factors, MAP, and UAPI) detected 80% of PE cases with 98% specificity (AUC 0.987; 95% CI, 0.908-1.00; p = 0.0001). The combination of maternal factors and MAP detected 80% of cases with 66% specificity (AUC 0.857; 95% CI, 0.733-0.939; p = 0.0001). Maternal factors alone showed 40% sensitivity and 87% specificity (AUC 0.713; 95% CI, 0.571-0.830; p = 0.2487).

CONCLUSION

Screening for preeclampsia at 11+0 - 14+0 weeks of gestation using the FMF algorithm that combines maternal factors, MAP, and UAPI demonstrates high predictive performance and is applicable for early PE risk assessment in the Indonesian population.