OC07.02: Multicentre screening for pre‐eclampsia by maternal factors and biomarkers at 11–13 weeks' gestation: comparison to NICE guidelines and ACOG recommendations

Abstract

Oral communication abstractsquestions on the origin aetiology point for these disorders, largely thought to arise from defective placentation in the first trimester. OC07.02Multicentre screening for pre-eclampsia by maternal factors and biomarkers at 11-13 weeks' gestation: comparison to NICE guidelines and ACOG recommendations Methods: This was a prospective European multicentre study of screening for PE in 8,775 singleton pregnancies at 11-13 weeks' gestation in 12 hospitals. A previously published FMF algorithm was used for the calculation of patient-specific risk of PE in each patient. The detection rates (DR) and false positive rates (FPR) for delivery with PE at <32, <37 and >37 weeks were estimated and compared to those derived from application of NICE guidelines and ACOG recommendations. Results: In the study population there were 239 (2.7%) cases that developed PE, including 17 (0.2%), 59 (0.7%) and 180 (2.0%) at <32, <37 and >37 weeks, respectively. Screening with use of the FMF algorithm and the combination of maternal factors, mean arterial pressure (MAP), uterine artery pulsatility index (UTPI) and serum placental growth factor (PLGF) detected 100% (95% CI 80-100) for PE at <32 weeks, 75% (95% CI 62-85) for PE at <37 weeks and 43% (95% CI 35-50) for PE at >37 weeks, at 10.0% FPR. Screening with use of NICE guidelines detected 41% (95% CI 18-67) for PE at <32 weeks, 39% (95% CI 27-53) for PE at <37 weeks and 34% (95% CI 27-41) for PE at >37 weeks, at 10.3% FPR. Screening with use of ACOG recommendations detected 94% (95% CI 71-100) for PE at <32 weeks, 90% (95% CI 79-96) for PE at <37 weeks and 89% (95% CI 84-94) for PE at >37 weeks, at 64.3% FPR. Conclusions: Performance of screening for PE at 11-13 weeks' gestation by the FMF algorithm and combination of maternal factors, MAP, UTPI and PLGF is by far superior to the methods recommended by NICE and ACOG. Objectives: To evaluate the discriminative capacity of uterine artery pulsatility index (UtA-PI) in the identification of women remaining at high risk of pre-eclampsia (PE) after first trimester initiation of aspirin. Methods: We conducted a post-hoc analysis of data from a clinical randomised controlled trial of women with prior PE singleton fetus randomised to either 80 mg or 160 mg at bedtime from 10-14 weeks and followed until delivery. A follow-up visit was planned at 16-18 weeks for measurement of mean arterial blood pressure (MAP), UtA-PI and PFA-100 to evaluate aspirin non-responsiveness (PFA-100<145). Mean difference and ROC curves analyses with area under the curve (AUC), detection rate (DR) and false-positive rates (FPR) were used. Results: We observed 14 cases (13%) of PE and 3 (3%) cases of preterm PE out of 106 women with complete follow-up. UtA-PI at 16-18 weeks was discriminative of participants who developed preterm PE (AUC: 0.89; 95%CI: 0.77-1.00) but, not for those who developed term PE (AUC: 0.50; 95%CI: 0.32-0.69). Regarding aspirin resistance, participants who developed PE had a lower PFA-100 (mean difference: 50; 95%CI: 21-79,...

Pre‐eclampsia screening in Denmark (PRESIDE): national validation study

“…The FMF combined screening is superior to the traditional approach and has a DR of preterm PE of 75% at a 10% FPR 13 . External validation studies of the FMF algorithm in American 14 , Australian 15,16 , European 6,17–23 , Brazilian 24,25 and Asian 26,27 populations have confirmed the predictive performance, although the DRs varied, reflecting population differences in demographic characteristics.…”

“…Screening according to the National Institute for Health and Care Excellence (NICE) guidelines provides detection rates (DRs) of 39% for PE with delivery < 37 weeks' gestation at a false‐positive rate (FPR) of 10.2%. The DR of screening for PE with delivery < 37 weeks according to the American College of Obstetricians and Gynecologists (ACOG) recommendations is 90% at a FPR of 64.2% 6 . The current Danish national guidelines for offering ASA treatment are based on maternal risk factors and correspond largely to having at least one NICE major risk factor 7 .…”

ASPRE trial: effects of aspirin on mean arterial blood pressure and uterine artery pulsatility index trajectories in pregnancy

“…Traditional methods used to identify women at increased risk of pre-eclampsia rely on the presence of risk factors related to maternal characteristics and medical and obstetric history, but they fail to detect the majority of women who later develop the disease 1 . More accurate risk stratification in the first trimester of pregnancy can be achieved with the use of the Fetal Medicine Foundation (FMF) competing-risks algorithm that combines maternal characteristics and medical and obstetric history with mean arterial pressure (MAP), mean uterine artery pulsatility index (UtA-PI) on Doppler ultrasound and serum placental growth factor (PlGF) to produce individual risk estimates [1][2][3] .…”

Screening for pre‐eclampsia with competing‐risks model using placental growth factor measurement in blood samples collected before 11 weeks' gestation

“…PlGF adds substantially to a first‐trimester screening model for PE, which includes maternal characteristics, mean arterial pressure (MAP) and uterine artery pulsatility index (UtA‐PI), developed by the Fetal Medicine Foundation (FMF) 10–12 . At 11–14 weeks' gestation, this model detects approximately 75% of preterm (delivery < 37 weeks' gestation) PE cases at a screen‐positive rate (SPR) of 10%, and it has been validated in several populations 13–18 . In the FMF study, biomarkers (including PlGF and pregnancy‐associated plasma protein‐A (PAPP‐A) in serum samples) were assessed between 11 and 14 weeks' gestation 19 , and this practice has been followed in subsequent validation studies.…”