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A Novel Method for Involving Women of Color at High Risk for Preterm Birth in Research Priority Setting
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A Novel Method for Involving Women of Color at High Risk for Preterm Birth in Research Priority Setting

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ASPRE trial: incidence of preterm pre-eclampsia in patients fulfilling ACOG and NICE criteria according to risk by

L C Poon1,2, D L Rolnik3, M Y Tan3,4

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

Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology
|January 31, 2018
PubMed

Insights

Screening for preterm pre-eclampsia (PE) using National Institute for Health and Care Excellence (NICE) or American College of Obstetricians and Gynecologists (ACOG) criteria, but not the Fetal Medicine Foundation (FMF) algorithm, significantly reduces PE risk. This supports personalized risk-based screening.

Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine
  • Diagnostic Accuracy

Background:

  • Preterm pre-eclampsia (PE) poses significant risks to maternal and fetal health.
  • Current screening guidelines, such as those from NICE and ACOG, identify women at risk.
  • The Fetal Medicine Foundation (FMF) algorithm offers a comprehensive screening method combining maternal factors and biomarkers.

Purpose of the Study:

  • To determine the incidence of preterm PE in women identified as screen-positive by NICE and ACOG criteria.
  • To compare this incidence with that in women screened by the FMF algorithm (both screen-positive and screen-negative).
  • To evaluate the effectiveness of the FMF algorithm in risk stratification for preterm PE.

Main Methods:

  • Secondary analysis of data from the ASPRE study.
  • Inclusion of 34,573 women with singleton pregnancies undergoing prospective screening for preterm PE at 11-13 weeks' gestation.
  • Calculation of preterm PE incidence based on NICE, ACOG, and FMF screening criteria.

Main Results:

  • Women meeting NICE or ACOG criteria but screening negative by FMF algorithm had a significantly reduced incidence of preterm PE (0.25% for ACOG, 0.65% for NICE high-risk, 0.42% for NICE moderate-risk).
  • The relative incidence of preterm PE in FMF screen-negative versus screen-positive individuals was consistently low across criteria (0.051 to 0.085).
  • The FMF algorithm demonstrated superior risk stratification compared to NICE and ACOG criteria alone.

Conclusions:

  • Screening positive by ACOG or NICE criteria but negative by the FMF algorithm indicates a substantially reduced risk of preterm PE.
  • These findings reinforce the value of personalized, risk-based screening using a combination of maternal factors and biomarkers.
  • The FMF algorithm provides a more accurate risk assessment for preterm PE.
Abstract

Keywords:
ACOG guidelinesBayes' theoremNICE guidelinesfirst-trimester screeningmean arterial pressureplacental growth factorpre-eclampsiapregnancy-associated plasma protein-Auterine artery Doppler

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