Screening for pre‐eclampsia: Performance of National Institute for Health and Care Excellence guidelines versus American College of Obstetricians and Gynecologists recommendations

Abstract

Aim: The purpose of this study was to compare the accuracy of the National Institute for Health and Care Excellence (NICE) guidelines and the American College of Obstetricians and Gynecologists (ACOG) recommendations for pre-eclampsia (PE) screening. Methods: This retrospective study included 4600 Thai pregnant women who received maternity care between January 2006 and December 2015 at Songklanagarind Hospital, a tertiary care center in southern Thailand. The medical data of each participant were assessed using the NICE and ACOG criteria to identify maternal risk for PE. The sensitivity, specificity, positive likelihood ratio and negative likelihood ratio for detecting pregnancies complicated with PE according to each guideline were calculated. Receiver operating characteristic (ROC) curves were constructed to compare the predictive performance. Results: Pre-eclampsia was found in 167 cases (3.63%). The ACOG recommendations achieved ROC area 0.70 (58.1% sensitivity with 82.4% specificity) for PE at any gestation and ROC area 0.66 (62.9% sensitivity with 69.0% specificity) for PE which required delivery before 37 weeks' gestation. ROC areas based on the NICE guidelines were 0.64 (35.3% sensitivity with 92.5% specificity) and 0.59 (34.8% sensitivity with 83.4% specificity) for all PE and preterm PE, respectively. The ACOG criteria were significantly more accurate than the NICE criteria for detecting maternal risk for all PE, preterm PE and nulliparity cases (P values <0.05). Conclusion: For Thai pregnant women, screening for PE with maternal risk factors according to the ACOG recommendations was more effective in identifying high-risk pregnancies than the NICE guidelines.

Low‐dose aspirin for prevention of preeclampsia: Implementation of the NICE guideline in Thailand

“…Recently, we did a study on the performance of the NICE guideline in our population. The DR for overall PE was only 35.33% with a 7.49% false-positive rate (FPR), 16 a finding similar to other reports in which the DRs of PE by NICE ranged 13.1%-38.2% at 4.0%-15.3% FPR. [17][18][19][20] As a result, targeted aspirin usage in pregnant women classified as high risk was lower than it should have been.…”

Combined maternal risk factors and the Quadruple test to predict late-onset preeclampsia in pregnant Thai women

“…Patients who develop late-onset PE had a high BMI, increased cardiac output, and relatively unchanged total vascular resistance [ 6 ]. Previous reports have focused on predicting late-onset PE (severe and non-severe) and have reported that maternal risk factors alone result in an overall detection rate of 33.5–62.9% [ 20 , 27 ] using the criteria proposed by the NICE and ACOG. The detection rate was slightly improved when combined with Doppler ultrasound, serum pregnancy-associated plasma protein A, and placental growth factor in the first trimester gestation [ 20 ].…”

“…Our study revealed that inhibin A had the highest AUC (0.708) for predicting late-onset PE with severe features, and when we combined inhibin A with maternal risk factors, the AUC improved to 0.775, with a high predictive value among patients with a score > 60. This predictive model with both maternal risk factors and inhibin A also had a higher predictive ability than the model using maternal risk factors alone, proposed by the NICE and ACOG guidelines (AUC 0.591 [0.538–0.644] and 0.695 [0.604–0.714], respectively), in predicting any PE at < 37 weeks’ gestation in the Asian population [ 27 ].…”

“…morbidity and mortality, the vast majority of PE cases are late-onset type [ 25 , 26 ]. Our institute, Songklanagarind Hospital, a referral center in southern Thailand, has a total PE incidence of 3.63%, with 1.26% and 2.37% being early- and late-onset type, respectively [ 27 ]. The morbidity and mortality associated with late-onset PE patients more commonly affect mothers than neonates.…”

“…Several previous studies [ 33 – 39 ] have reported that abnormal Quad test results could predict the detection of high-risk PE patients. Although abnormal serum levels in the Quad test might be associated to PE, neither abnormal serum levels nor maternal risk factors alone resulted in a high detection rate of late-onset PE [ 22 – 24 , 27 , 32 ].…”