Preeclampsia screening that utilized biomarkers produced better outcomes than the United Kingdom’s existing National Institute for Health and Care Excellence guidelines, according to findings recently published in Ultrasound in Obstetrics & Gynecology.
Current U.K. guidelines deem women with a history of hypertensive diseases in an earlier pregnancy, or who have autoimmune disease, chronic hypertension, chronic kidney disease, or diabetes mellitus to be at high risk for developing preeclampsia. Women with two or more of the following are also at increased risk for preeclampsia: first pregnancy occurring aged 40 or older, 10 years or more between pregnancies, a BMI higher than 35 kg/m2 and/or a family history of preeclampsia.
“The performance of such an approach, which essentially treats each risk factor as a separate screening test with additive detection rate and screen-positive rate, and the uptake of aspirin by the high-risk group, has not been evaluated by prospective studies,” M.Y. Tan, of King’s College Hospital in London, and colleagues wrote.
In the new screening approach, researchers studied the known risk factors along with a combination of biomarkers: serum pregnancy-associated plasma protein-A data, uterine artery pulsatility indexes, serum placental growth factors, medical histories, maternal characteristics and measurements of mean arterial pressure. A total of 16,747 singleton pregnancies 11 to 13 weeks along in gestation were prospectively analyzed.
Tan and colleagues wrote that utilizing the NICE guidelines yielded a 10.3% detection rate. The new screening approach led to a 30.4% detection rate for all cases of preeclampsia and 40.8% of preterm cases. In addition, researchers found that the preeclampsia detection rate in women of any gestational age whose risk factors were assessed in addition to measurement of mean arterial pressure and serum pregnancy-associated plasma protein-A was 42.5%, which exceeded that of the existing UK method by 12.1% (95% CI, 7.9–16.2%). In screening for preterm preeclampsia that utilized maternal factors, mean arterial pressure and serum placental growth factors, the detection rate was 69%, which surpassed the existing UK method by 28.2% (95% CI, 19.4–37%). When uterine artery pulsatility index was added to this last set of criteria, the detection rate improved to 82.4% which was 41.6% higher than the existing UK method (95% CI, 33.2–49.9%).
“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-[preeclampsia] and would therefore benefit from taking prophylactic aspirin,” according to a press release. “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 U.S. Preventive Services Task Force recommended in 2017 that screening for preeclampsia with BP measurements throughout a patient’s pregnancy take place. – by Janel Miller
Healio Family Medicine was unable to determine the authors relevant financial disclosures prior to publication.