Preeclampsia screening method found superior to current tests

March 14, 2018, Wiley

New research highlights a more accurate way to screen for preeclampsia in pregnant women than currently recommended methods. Published early online in Ultrasound in Obstetrics & Gynecology, the study challenges the UK's current guidelines on the management of hypertensive disorders during pregnancy.

Preeclampsia (PE) affects approximately 2% to 3% of pregnancies and can have serious health effects for both the mother and child. The condition is characterized by . Some affected women develop very severe disease associated with kidney, liver, bleeding and neurological problems. The fetus may experience impaired growth and possibly die. Risks are especially high when PE leads to preterm birth before 37 weeks' gestation (preterm-PE), which itself is associated with long-term health issues for the children.

Recent evidence suggests that giving low-dose aspirin to women at of the disorder can reduce the prevalence of the severest form of preeclampsia by more than 60%, but the treatment must be started before 16 weeks' gestation. Therefore, early detection is key. In the UK, identification of high-risk women who could benefit from aspirin is based on a checklist of maternal characteristics and as defined by the National Institute for Health and Care Excellence (NICE) guidelines. An alternative approach combines known risk factors with the results of various maternal biophysical and biochemical measurements taken at 11 to 13 weeks' gestation: mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI), and serum placental growth factor (PlGF); known as the first-trimester combined test.

This latest Ultrasound in Obstetrics & Gynecology study—called the Screening ProgRamme for prE-Eclampsia (SPREE) study—was designed to compare the performance of first-trimester screening for PE by this alternative approach with that of the current NICE method. The study was conducted in seven National Health Service (NHS) maternity hospitals in England between April and December 2016. Singleton pregnancies at 11 to 13 weeks' gestation had recordings of maternal characteristics and medical history, as well as measurements of MAP, UtA-PI, and PlGF.

PE occurring at any point during pregnancy (all-PE) was found in 473 (2.8%) of the 16,747 pregnancies in the study, and preterm-PE was seen in 142 (0.8%). The detection rates of the NICE checklist for all-PE and preterm PE were 30.4% and 40.8%, respectively. Furthermore, compliance with the NICE recommendation that women at high risk for PE should be treated with aspirin from the first trimester was only 23%. If screening was carried out by the first-trimester combined test, the detection rates for all-PE and preterm PE were increased to 42.5% and 82.4%, respectively.

The findings indicate that the use of the simple algorithm based on maternal characteristics and easily measurable markers can identify approximately 80% of women who would go on to develop preterm-PE and would therefore benefit from taking prophylactic aspirin. The first-trimester combined test is freely available as a simple and user-friendly risk calculator via http://www.fetalmedicine.org and on the Fetal Medicine Foundation app.

"The SPREE study has provided definitive proof to support risk-based screening for preterm-PE using various biomarkers. It is now time to revise the professional guidelines and to move away from using a checklist-based method for screening." said co-senior author Liona Poon, MD, of King's College London, in London.

Basky Thilaganathan, MD, PhD, the journal's Editor-in-Chief, noted that the findings have important clinical implications. "Poon and colleagues have demonstrated that effective early pregnancy screening for preeclampsia is possible in a routine NHS hospital setting. They make a compelling case for the routine implementation of this protocol to halve the cases of early-onset severe preeclampsia cases in the UK" he said.

Explore further: Aspirin reduces risk of pre-eclampsia in pregnant women

More information: Comparison of diagnostic accuracy of early screening for pre-eclampsia by NICE guidelines and a method combining maternal factors and biomarkers: results of SPREE, Ultrasound in Obstetrics & Gynecology, DOI: 10.1002/uog.19039

Related Stories

Aspirin reduces risk of pre-eclampsia in pregnant women

June 28, 2017
Taking a low-dose aspirin before bed can reduce the risk of pre-eclampsia, which can cause premature birth and, in extreme cases, maternal and foetal death.

Scientists discover critical molecular biomarkers of preeclampsia

February 21, 2018
Preeclampsia, a sudden pregnancy complication that can interfere with the blood flow to the placenta and possibly to the fetus, can lead to low birth weight, prematurity and even death. It is also a leading cause of maternal ...

Detailed medical history best screening for preeclampsia

August 23, 2015
(HealthDay)—Taking a detailed medical history remains the best and only recommended screening approach for preeclampsia, according to a practice bulletin published in the September issue of Obstetrics & Gynecology.

Screening for preeclampsia in pregnant women recommended

April 25, 2017
The U.S. Preventive Services Task Force (USPSTF) recommends screening for preeclampsia in pregnant women with blood pressure measurements throughout pregnancy. The report appears in the April 25 issue of JAMA.

Research offers recommendations for use of aspirin to prevent preeclampsia

December 16, 2015
To prevent preeclampsia, new research suggests that low-dose aspirin should be given prophylactically to all women at high risk (those with diabetes or chronic hypertension) and any woman with two or more moderate risk factors ...

In vitro fertilization linked with increased risk of spontaneous preterm birth

November 8, 2017
A new analysis of published studies found an approximate 80% increased risk of spontaneous preterm birth (both before 37 and 34 weeks) when women become pregnant via in vitro fertilization (IVF) than through spontaneous conception.

Recommended for you

Undiagnosed STIs can increase negative PMS symptoms

September 17, 2018
Women that have undiagnosed sexually transmitted infections may be at greater risk of experiencing negative premenstrual symptoms (PMS), according to new Oxford University research.

High dose folic acid does not prevent pre-eclampsia in high risk women

September 13, 2018
Taking high dose folic acid supplements in later pregnancy (beyond the first trimester) does not prevent pre-eclampsia in women at high risk for this condition, finds a randomised controlled trial published by The BMJ today.

Study finds air purifiers may benefit fetal growth

September 12, 2018
A new study led by SFU health sciences researchers Prabjit Barn and Ryan Allen reveals fetal growth may improve if pregnant women use portable air purifiers inside their homes.

Delayed childbearing is a growing source of multiple births, study shows

September 12, 2018
Starting in the 1980s, the number of multiple births—twins, triplets, quadruplets and quintuplets—steadily increased from about 20 sets per 1,000 live births to almost 35 sets per 1,000 live births in the 2010s.

Transforming pregnancy research with a smartphone app

September 5, 2018
For years, pregnant women have been underrepresented in biomedical research. Current treatments, interventions and guidelines do a poor job of taking into consideration the diverse characteristics of all pregnant women.

For women undergoing IVF, is fresh or frozen embryo transfer best?

August 21, 2018
The world's first baby born via in-vitro fertilization turned 40 years old this summer. Still, after four decades, IVF is a relatively new field with ongoing debate on how to get the best results for families who have placed ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.