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Two-stage screening for preterm preeclampsia at 11-13 weeks' gestation
Alan Wright1, David Wright1, Argyro Syngelaki2
1Institute of Health Research, University of Exeter, Exeter, United Kingdom.
American Journal of Obstetrics and Gynecology
|November 11, 2018
Summary
A two-stage screening approach for preeclampsia using maternal factors and biomarkers can effectively identify high-risk pregnancies. This method reduces the need for universal biomarker testing, offering financial benefits.
Area of Science:
- Maternal-fetal medicine
- Biomarker discovery
- Pregnancy screening
Background:
- Preeclampsia screening at 11-13 weeks gestation using maternal factors, mean arterial pressure, uterine artery pulsatility index, and placental growth factor (triple test) predicts early and preterm preeclampsia with high accuracy.
- Aspirin administration in high-risk pregnancies significantly reduces preeclampsia rates.
- Routine prenatal care includes maternal history and blood pressure, but additional tests incur costs.
Purpose of the Study:
- To evaluate a two-stage preeclampsia screening strategy.
- To assess the feasibility of using initial screening with maternal factors alone or combined with some biomarkers.
- To determine if a full triple test can be reserved for a selected subgroup in second-stage screening.
Main Methods:
- Prospective screening of 61,174 singleton pregnancies at 11-13 weeks gestation.
- Calculation of patient-specific preeclampsia risks using a competing risks model incorporating maternal characteristics and biomarkers (mean arterial pressure, uterine artery pulsatility index, placental growth factor).
- Estimation of detection and screen-positive rates for preterm and early preeclampsia under different two-stage screening policies.
Main Results:
- First-stage screening using maternal factors alone allows reserving measurements of mean arterial pressure, uterine artery pulsatility index, and placental growth factor for 70% of the population with comparable detection and screen-positive rates.
- Using maternal factors, mean arterial pressure, and uterine artery pulsatility index in first-stage screening allows reserving placental growth factor for 30-40% of the population.
- Using maternal factors, mean arterial pressure, and placental growth factor in first-stage screening allows reserving uterine artery pulsatility index for 20-30% of the population.
Conclusions:
- A two-stage screening approach is effective for preeclampsia detection.
- Biomarker testing can be targeted to a subgroup of the population, reducing overall testing costs.
- This strategy offers financial benefits compared to universal screening.