Multicenter screening for pre‐eclampsia by maternal factors and biomarkers at 11–13 weeks' gestation: comparison with NICE guidelines and ACOG recommendations

Abstract

To compare the performance of screening for preeclampsia (PE) based on risk factors from the medical history, as recommended by NICE and ACOG, with the method proposed by the Fetal Medicine Foundation (FMF), which uses Bayes theorem to combine the a priori risk from maternal factors, derived by a multivariable logistic model, with the results of various combinations of biophysical and biochemical measurements. This was a prospective multicenter study of screening for PE in 8,775 singleton pregnancies at 11–13 weeks’ gestation. 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. According to NICE, all high-risk pregnancies should be offered low-dose aspirin. According to ACOG, use of aspirin should be reserved for women with history of PE in ≥2 previous pregnancies or PE requiring delivery at <34 weeks’ gestation. 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) of PE at <32 weeks, 75% (95% CI 62–85) of PE at <37 weeks and 43% (95% CI 35–50) of PE at ≥37 weeks, at 10.0% FPR. Screening with use of NICE guidelines detected 41% (95% CI 18–67) of PE at <32 weeks, 39% (95% CI 27–53) of PE at <37 weeks and 34% (95% CI 27–41) of PE at ≥37 weeks, at 10.2% FPR. Screening with use of ACOG recommendations detected 94% (95% CI 71–100) of PE at <32 weeks, 90% (95% CI 79–96) of PE at <37 weeks and 89% (95% CI 84–94) of PE at ≥37 weeks, at 64.2% FPR. Screening based on the ACOG recommendations for use of aspirin detected 6% (95% CI 1–27) of PE at <32 weeks, 5% (95% CI 2–14) of PE at <37 weeks and 2% (95% CI 0.3-5) of PE at ≥37 weeks, at 0.2% FPR. 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.