Clinical chemistry · 2025
From Diagnosis to Delivery: A Look at the Continuing Gap in Maternal Testing.
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Torres Callie, Kelly Jeannie, Gronowski Ann M
Аннотация
BACKGROUND: Hypertension, infection, hemorrhage, cardiovascular events, gestational diabetes, anemia, and miscarriage remain the primary cause of maternal mortality and morbidity. Despite advances in maternal health, there remains a gap in the ability to accurately diagnose, or predict the risk of, certain pregnancy-related conditions.
CONTENT: Here, we discuss preterm delivery, preeclampsia, ectopic pregnancy, gestational diabetes, and detection of fetal anomalies. These are 5 examples of pregnancy-related conditions for which a significant diagnostic gap still exists. We note that many of the available tests used in this field promote a high negative predictive value (NPV), when tests with high positive predictive value (PPV) are needed to drive treatment.
SUMMARY: To improve the modes of maternal testing, researchers need to establish the performance criteria necessary for the given condition. For low-prevalence conditions with potentially catastrophic outcomes, a single test needs extremely high sensitivity and specificity to achieve the PPV required to identify the small number of affected women who would benefit from intensive intervention. Alternatively, 2-step approaches could be used with a highly sensitive screen followed by a highly specific test. However, the solution to improving maternal morbidity and mortality is 2-fold: both affordable, effective, and rapid modes of testing; and safer, more effective treatments are needed.
CONTENT: Here, we discuss preterm delivery, preeclampsia, ectopic pregnancy, gestational diabetes, and detection of fetal anomalies. These are 5 examples of pregnancy-related conditions for which a significant diagnostic gap still exists. We note that many of the available tests used in this field promote a high negative predictive value (NPV), when tests with high positive predictive value (PPV) are needed to drive treatment.
SUMMARY: To improve the modes of maternal testing, researchers need to establish the performance criteria necessary for the given condition. For low-prevalence conditions with potentially catastrophic outcomes, a single test needs extremely high sensitivity and specificity to achieve the PPV required to identify the small number of affected women who would benefit from intensive intervention. Alternatively, 2-step approaches could be used with a highly sensitive screen followed by a highly specific test. However, the solution to improving maternal morbidity and mortality is 2-fold: both affordable, effective, and rapid modes of testing; and safer, more effective treatments are needed.