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Effect of routine first-trimester combined screening for pre-eclampsia on small-for-gestational-age birth: secondary
G P Guy1,2, K Leslie1,3, D Diaz Gomez1
1Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK.
Insights
The Fetal Medicine Foundation (FMF) screening program significantly reduced term small-for-gestational age (SGA) births by 45.1% but did not impact more severe SGA cases. Further strategies are needed for SGA births below the 5th percentile.
Area of Science:
- Maternal-fetal medicine
- Prenatal screening and diagnostics
- Obstetrics and Gynecology
Background:
- First-trimester screening for pre-eclampsia is crucial for early intervention.
- The Fetal Medicine Foundation (FMF) algorithm offers a multimodal approach combining various risk factors.
- Evaluating the impact of such programs on fetal growth outcomes like small-for-gestational age (SGA) is essential.
Purpose of the Study:
- To assess the effect of a first-trimester combined screening program for pre-eclampsia, utilizing the FMF algorithm, on the incidence of SGA at birth.
- To determine the program's impact on other adverse pregnancy outcomes.
Main Methods:
- Retrospective cohort study comparing 7720 women screened via the UK National Institute for Health and Care Excellence (NICE) approach with 4841 women screened by the FMF multimodal approach.
- The FMF approach integrated maternal risk factors, blood pressure, pregnancy-associated plasma protein-A, and uterine artery Doppler.
- Interrupted time series analysis (ITSA) was used to evaluate outcomes including SGA, neonatal unit admission, intrauterine demise, neonatal death, and hypoxic-ischemic encephalopathy.
Main Results:
- No significant differences were observed in intrauterine demise, neonatal death, or hypoxic-ischemic encephalopathy rates between the groups.
- The FMF screening program led to a significant 45.1% relative reduction in term SGA births below the 10th percentile (P=0.004).
- No significant reduction was found for term SGA births below the 5th or 3rd percentile.
Conclusions:
- The FMF algorithm-based first-trimester screening, coupled with a care package including serial ultrasounds and elective birth from 40 weeks, effectively reduced term SGA births (<10th percentile).
- This approach did not significantly alter rates of more severe SGA (<5th or <3rd percentile).
- Additional screening strategies are necessary to improve outcomes for the most severely SGA neonates (<5th percentile).
Objective:
To evaluate the impact of a first-trimester combined screening program for pre-eclampsia, based on the Fetal Medicine Foundation (FMF) algorithm, on the rate of small-for-gestational age (SGA) at birth and adverse pregnancy outcome.
Methods:
This was a retrospective cohort study of data obtained from a London tertiary hospital between January 2017 and March 2019. The data were derived from a secondary analysis of the cohort evaluated in a clinical-effectiveness study on the implementation of a first-trimester screening program for pre-eclampsia. The cohort included 7720 women screened according to the UK National Institute for Health and Care Excellence (NICE) risk-based approach and 4841 women screened by the FMF multimodal approach, which combines maternal risk factors, blood pressure, pregnancy-associated plasma protein-A and uterine artery Doppler indices. The care package for the FMF-screened group included 150-mg aspirin prophylaxis, ultrasound scans at 28 and 36 weeks' gestation and scheduled delivery at 40 weeks. Outcome measures included the rates of SGA neonates at birth, admission to the neonatal unit, intrauterine demise, neonatal death and hypoxic-ischemic encephalopathy assessed by interrupted time series analysis (ITSA).
Results:
There was no significant difference in the rates of intrauterine demise, neonatal death and hypoxic-ischemic encephalopathy between the FMF-screened and NICE-screened cohorts. ITSA showed a significant reduction in the rate of term SGA birth < 10th percentile at 21 months following implementation of the FMF screening program, with a relative effect reduction of 45.1% (P = 0.004). However, there was no significant relative effect reduction in term SGA birth < 5th or < 3rd percentile.
Conclusions:
First-trimester combined screening for pre-eclampsia based on the FMF algorithm accompanied by a care package including serial ultrasound scans for growth evaluation and elective birth from 40 weeks' gestation resulted in a significant 45% relative effect reduction in term SGA birth < 10th percentile but did not affect term SGA birth < 5th or < 3rd percentile. Further screening strategies to detect and improve the outcome of cases with SGA birth < 5th percentile need to be considered. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
