Pre-eclampsia screening in the first trimester - preemptive action to prevent the peril

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Perinatology

Background:

• Pre-eclampsia affects 2-5% of pregnancies, posing risks to mother and fetus.
• Current risk factor-based screening methods for pre-eclampsia have suboptimal performance.
• Early pre-eclampsia (<34 weeks) is associated with the majority of severe complications.

Purpose of the Study:

• To evaluate a combined multimarker screening strategy for pre-eclampsia in the first trimester.
• To assess the efficacy of low-dose aspirin in preventing preterm pre-eclampsia in screen-positive women.

Main Methods:

• Combined screening involves maternal history, mean arterial pressure, placental growth factor, pregnancy-associated plasma protein-A, and uterine artery pulsatility index.
• Screening is performed between 11 and 13+6 weeks of gestation.
• Bayes' theorem is used to calculate a-priori risk, with a threshold of >1:100 for preterm pre-eclampsia defining screen positivity.

Main Results:

• The multimarker model detects 96% of early preterm pre-eclampsia (<34 weeks) and 77% of preterm pre-eclampsia (<37 weeks) with a 10% false positive rate.
• Low-dose aspirin (150 mg) significantly reduces the incidence of preterm and early pre-eclampsia.
• Aspirin use in screen-positive women shows minimal adverse effects on mother, fetus, and neonate.

Conclusions:

• First-trimester combined multimarker screening is an effective strategy for identifying women at high risk of pre-eclampsia.
• Universal screening and subsequent low-dose aspirin intervention for screen-positive individuals can significantly improve pregnancy outcomes.
• This screening protocol, endorsed by international societies, should be offered to all pregnant women.