Implementation of routine first‐trimester combined screening for preeclampsia based on the Gaussian algorithm: A clinical effectiveness study

Abstract

Objective: To evaluate the clinical effectiveness of the routine first-trimester screening for preeclampsia (PE) after being implemented in six Catalan maternities. Methods: Participants in the reference group were recruited prospectively between October 2015 and September 2017. Participants in the study group were recruited retrospectively between November 2018 and May 2019, after implementing the screening program. PE risk was assessed between 11 + 0 and 13 + 6 weeks of gestation using the Gaussian algorithm combining maternal characteristics, mean arterial blood pressure, uterine artery pulsatility index, and maternal serum pregnancy-associated plasma protein-A. Women with a risk ≥1/137 were prescribed daily salicylic acid (150 mg) until 36 weeks of gestation.Results: Preterm PE occurred in 30 of 2641 participants (1.14%) in the reference group, as compared with 18 of 2848 participants (0.63%) in the study group (OR: 0.55; 95% CI, 0.31-0.99; P = 0.045). In the reference group, 37 participants (1.40%) were admitted to ICU, as compared with 23 participants (0.81%) in the study group

Do first‐trimester screening algorithms for preeclampsia aligned to use of preventative therapies reduce the prevalence of pre‐term preeclampsia: A systematic review and meta‐analysis

“…All included studies were carried out in high‐income settings, potentially reflecting access to early pregnancy care and ultrasound as part of algorithm‐based first‐trimester screening assessments. Six articles reported outcomes following screening linked to preventative therapy in unselected populations of singleton pregnancies 26,28–32 . One study reported outcomes related to prophylactic therapy within a sub‐set of women who had screened high risk 27 ; this was matched with a subsequent publication regarding the screening outcomes of the same population to establish event rates across the entire unselected cohort 33 .…”

“…The literature search identified 1102 studies, of which 47 were selected for full‐text evaluation. The inclusion criteria were met in 7 studies with a total of 377,790 participants 26–32 . Details of the included studies are shown in Table 1.…”

“…The first‐trimester screening algorithm used most commonly was the competing‐risks model published by The Fetal Medicine Foundation 26–29,31 . Two other studies described the use of the Gaussian algorithm 30,32 . Studies using both screening strategies were included as similar predictive performance has been demonstrated through external validation 15 .…”

“…Whilst the ASPRE trial 27 reported reductions in early onset preeclampsia and stillbirth and no difference in small for gestational age infants with aspirin therapy in high‐risk women, results could not be included in this analysis as screening performance related to these outcomes for the entire unselected cohort have not been published. One study only reported small for gestational age infants born prior to 37 weeks gestation 30 , which precluded analysis due to only two remaining studies that reported this outcome across all gestations.…”

“…Six articles reported outcomes following screening linked to preventative therapy in unselected populations of singleton pregnancies. 26,[28][29][30][31][32] One study reported outcomes related to prophylactic therapy within a sub-set of women who had screened high risk 27 ; this was matched with a subsequent publication regarding the screening outcomes of the same population to establish event rates across the entire unselected cohort. 33 The first-trimester screening algorithm used most commonly was the competing-risks model published by…”