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ASPRE trial: performance of screening for preterm pre-eclampsia.

D L Rolnik1, D Wright2, L C Y Poon1,3

  • 1King's College Hospital, London, UK.

Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology
|July 26, 2017
PubMed
Summary

This study evaluated a combined screening method for pre-eclampsia (PE) in early pregnancy. The screening demonstrated effective detection rates for both preterm and term pre-eclampsia, supporting its clinical utility.

Keywords:
ASPRE trialfirst-trimester screeningmean arterial pressureplacental growth factorpre-eclampsiapregnancy-associated plasma protein-Apyramid of pregnancy careuterine artery Doppler

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Area of Science:

  • Maternal-fetal medicine
  • Obstetrics
  • Clinical trial methodology

Background:

  • Pre-eclampsia (PE) is a significant cause of maternal and neonatal morbidity.
  • Early screening and intervention are crucial for improving pregnancy outcomes.
  • The ASPRE (Combined Multimarker Screening and Randomized Patient Treatment with Aspirin for Evidence-Based Preeclampsia Prevention) trial investigated a novel screening algorithm.

Purpose of the Study:

  • To assess the performance of a combined first-trimester screening algorithm for preterm and term pre-eclampsia (PE).
  • To evaluate the detection rates (DRs) and false-positive rates (FPRs) of the screening algorithm in a large prospective cohort.
  • To compare the screening performance with the algorithm's development study.

Main Methods:

  • A prospective, first-trimester, multicenter study involving 26,941 singleton pregnancies.
  • Screening utilized an algorithm combining maternal factors, mean arterial pressure, uterine artery pulsatility index, and serum PAPP-A and PLGF.
  • Women with a preterm PE risk >1 in 100 were invited to a randomized trial of aspirin versus placebo.

Main Results:

  • The study included 25,797 pregnancies with 180 (0.7%) preterm PE and 450 (1.7%) term PE cases.
  • Combined screening at 11-13 weeks achieved a 76.7% DR for preterm PE and 43.1% DR for term PE.
  • The screen-positive rate was 10.5%, with a false-positive rate of 9.2% for the overall population.

Conclusions:

  • The performance of the combined screening algorithm in the ASPRE trial was comparable to the development study.
  • The screening demonstrated robust detection rates for preterm PE and moderate rates for term PE.
  • This multimodal screening approach shows promise for early identification of pregnancies at risk for pre-eclampsia.