Related Experiment Video
Updated: Jul 15, 2025
Modeling Encephalopathy of Prematurity Using Prenatal Hypoxia-ischemia with Intra-amniotic Lipopolysaccharide in Rats
Published on: November 20, 2015
First-trimester prediction of preterm pre-eclampsia and prophylaxis by aspirin: Effect on spontaneous and iatrogenic
Kypros H Nicolaides1, Argyro Syngelaki1,2, Liona C Poon3
1Fetal Medicine Research Institute, King's College Hospital, London, UK.
Insights
The Fetal Medicine Foundation triple test and NICE guidelines showed poor prediction for spontaneous preterm birth (PTB). Aspirin did not substantially reduce spontaneous PTB or iatrogenic PTB unrelated to pre-eclampsia.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Perinatal Health
Background:
- Preterm birth (PTB) remains a leading cause of neonatal morbidity and mortality.
- Accurate screening for PTB risk is crucial for timely intervention.
- Current screening guidelines, including the Fetal Medicine Foundation (FMF) triple test and National Institute for Health and Care Excellence (NICE) guidelines, require evaluation for their predictive performance.
Purpose of the Study:
- To assess the predictive accuracy of the FMF triple test and NICE guidelines for preterm birth (PTB).
- To evaluate the impact of aspirin in preventing PTB.
- To compare the effectiveness of two screening methods for PTB risk.
Main Methods:
- Secondary analysis of data from the SPREE study and the ASPRE trial.
- Inclusion of 16,451 singleton pregnancies screened at 11-13 weeks gestation.
- Comparison of FMF method and NICE guidelines for predicting spontaneous PTB (sPTB), iatrogenic PTB for pre-eclampsia (iPTB-PE), and iatrogenic PTB for other reasons (iPTB-noPE).
Main Results:
- The FMF triple test detected 17% of sPTB and 25% of iPTB-noPE, while NICE guidelines detected 12% and 19%, respectively, at a 10.2% screen-positive rate.
- The FMF triple test showed higher detection rates for iPTB-PE (82%) compared to NICE guidelines (39%).
- Aspirin use was associated with preventing 14% of sPTB, 65% of iPTB-PE, and 0% of iPTB-noPE.
Conclusions:
- Both the FMF triple test and NICE guidelines demonstrated poor predictive performance for spontaneous PTB and iatrogenic PTB unrelated to pre-eclampsia.
- Aspirin significantly reduced iatrogenic PTB due to pre-eclampsia but had a limited impact on spontaneous PTB.
- Improved screening strategies are needed for accurate PTB prediction, particularly for spontaneous PTB.
Objective:
To report the predictive performance for preterm birth (PTB) of the Fetal Medicine Foundation (FMF) triple test and National Institute for health and Care Excellence (NICE) guidelines used to screen for pre-eclampsia and examine the impact of aspirin in the prevention of PTB.
Design:
Secondary analysis of data from the SPREE study and the ASPRE trial.
Setting:
Multicentre studies.
Population:
In SPREE, women with singleton pregnancies had screening for preterm pre-eclampsia at 11-13 weeks of gestation by the FMF method and NICE guidelines. There were 16 451 pregnancies that resulted in delivery at ≥24 weeks of gestation and these data were used to derive the predictive performance for PTB of the two methods of screening. The results from the ASPRE trial were used to examine the effect of aspirin in the prevention of PTB in the population from SPREE.
Methods:
Comparison of performance of FMF method and NICE guidelines for pre-eclampsia in the prediction of PTB and use of aspirin in prevention of PTB.
Main Outcome Measure:
Spontaneous PTB (sPTB), iatrogenic PTB for pre-eclampsia (iPTB-PE) and iatrogenic PTB for reasons other than pre-eclampsia (iPTB-noPE).
Results:
Estimated incidence rates of sPTB, iPTB-PE and iPTB-noPE were 3.4%, 0.8% and 1.6%, respectively. The corresponding detection rates were 17%, 82% and 25% for the triple test and 12%, 39% and 19% for NICE guidelines, using the same overall screen positive rate of 10.2%. The estimated proportions prevented by aspirin were 14%, 65% and 0%, respectively.
Conclusion:
Prediction of sPTB and iPTB-noPE by the triple test was poor and poorer by the NICE guidelines. Neither sPTB nor iPTB-noPE was reduced substantially by aspirin.
More Related Videos
09:04Comprehensive Evaluation of the Effectiveness and Safety of Placenta-Targeted Drug Delivery Using Three Complementary Methods
Published on: September 10, 2018
12:02Human Primary Trophoblast Cell Culture Model to Study the Protective Effects of Melatonin Against Hypoxia/reoxygenation-induced Disruption
Published on: July 30, 2016
