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Screening for Preeclampsia and Fetal Growth Restriction in the First Trimester in Women without Chronic Hypertension
Piotr Tousty1, Magda Fraszczyk-Tousty2, Anna Golara1
1Department of Gynecology and Obstetrics, Pomeranian Medical University, 70-111 Szczecin, Poland.
Insights
First-trimester screening effectively identifies high-risk pregnancies for preeclampsia (PE) and fetal growth restriction (FGR). Acetylsalicylic acid (ASA) prophylaxis in these high-risk women may significantly reduce adverse perinatal outcomes.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Clinical Pharmacology
Background:
- First-trimester screening, utilizing Fetal Medicine Foundation (FMF) principles, identifies pregnancies at increased risk for preeclampsia (PE) and fetal growth restriction (FGR).
- Acetylsalicylic acid (ASA) is established to reduce PE and FGR incidence in high-risk populations.
- This study evaluated ASA implementation post-first-trimester screening in a Polish cohort without chronic hypertension, assessing its impact on perinatal complications.
Purpose of the Study:
- To evaluate the effectiveness of first-trimester screening in identifying pregnancies at high risk for PE and FGR.
- To assess the impact of acetylsalicylic acid (ASA) prophylaxis on perinatal outcomes in high-risk pregnancies.
- To determine the role of ASA in reducing the incidence of early-onset PE (eo-PE).
Main Methods:
- 874 patients underwent first-trimester ultrasound screening.
- Risk assessment for PE and FGR followed FMF guidelines, incorporating maternal history, mean arterial pressure (MAP), uterine artery pulsatility index (UtPI), PAPP-A, and PLGF.
- High-risk patients (>1:100 risk) received ASA 150 mg; perinatal outcomes were compared across risk groups.
Main Results:
- High-risk pregnancies showed significantly higher rates of pregnancy-induced hypertension (PIH), any PE, late-onset PE, FGR/small for gestational age (SGA), and gestational diabetes mellitus type 1 (GDM1).
- High-risk pregnancies were more likely to result in cesarean sections.
- Newborns from high-risk pregnancies had significantly lower birth weights, with increased risk for those below the 10th and 3rd percentiles.
Conclusions:
- First-trimester screening is a necessary and effective tool for identifying high-risk pregnancies for PE and FGR.
- ASA prophylaxis in high-risk pregnancies shows potential for significant beneficial effects on perinatal outcomes.
- This screening approach may substantially decrease the incidence of early-onset PE.
Background:
Nowadays, it is possible to identify a group at increased risk of preeclampsia (PE) and fetal growth restriction (FGR) using the principles of the Fetal Medicine Foundation (FMF). It has been established for several years that acetylsalicylic acid (ASA) reduces the incidence of PE and FGR in high-risk populations. This study aimed to evaluate the implementation of ASA use after the first-trimester screening in a Polish population without chronic hypertension, as well as its impact on perinatal complications.
Material And Methods:
A total of 874 patients were enrolled in the study during the first-trimester ultrasound examination. The risk of PE and FGR was assessed according to the FMF guidelines, which include the maternal history, mean arterial pressure (MAP), uterine artery pulsatility index (UtPI), pregnancy-associated plasma protein A (PAPP-A) and placental growth factor (PLGF). Among patients with a risk higher than >1:100, ASA was administered at a dose of 150 mg. Perinatal outcomes were assessed among the different groups.
Results:
When comparing women in the high-risk group with those in the low-risk group, a statistically significantly higher risk of pregnancy complications was observed in the high-risk group. These complications included pregnancy-induced hypertension (PIH) (OR 3.6 (1.9-7)), any PE (OR 7.8 (3-20)), late-onset PE (OR 8.5 (3.3-22.4)), FGR or small for gestational age (SGA) (OR 4.8 (2.5-9.2)), and gestational diabetes mellitus type 1 (GDM1) (OR 2.4 (1.4-4.2)). The pregnancies in the high-risk group were more likely to end with a cesarean section (OR 1.9 (1.2-3.1)), while the newborns had significantly lower weights (<10 pc (OR 2.9 (1.2-6.9)), <3 pc (OR 10.2 (2.5-41.7))).
Conclusions:
The first-trimester screening test for PE and FGR is a necessary and effective tool in identifying high-risk pregnancies. ASA prophylaxis among high-risk patients may have the most beneficial effect. Furthermore, this screening tool may significantly reduce the incidence of early-onset PE (eo-PE).
