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Published on: August 2, 2017
Expanding First-Trimester Preterm Preeclampsia Screening With Placental Growth Factor Testing
Nan Okun1, Jo-Ann Johnson2, Stefania Ronzoni3
1Department of Obstetrics and Gynecology, Sunnybrook Hospital, University of Toronto, ON.
Insights
Early aspirin can prevent preterm preeclampsia, but adherence is key. A multiple marker screening, including placental growth factor (PlGF), improves adherence and risk assessment for better pregnancy outcomes.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Clinical Chemistry
Background:
- Preterm preeclampsia affects 0.5% to 1% of pregnancies.
- Aspirin initiated before 16 weeks can prevent preterm preeclampsia, but effectiveness hinges on patient adherence.
- Current clinical factor-based screening for preterm preeclampsia has a high number needed to treat (NNT>100) and poor adherence.
Purpose of the Study:
- To evaluate the effectiveness of a multiple marker screening algorithm for preterm preeclampsia.
- To compare the NNT and treatment adherence of clinical factor-based screening versus a multiple marker algorithm.
- To determine if a combined approach can improve first-trimester risk assessment for preeclampsia.
Main Methods:
- Review of current evidence on preterm preeclampsia screening methods.
- Analysis of a multiple marker algorithm incorporating placental growth factor (PlGF) and standardized blood pressure measurement.
- Comparison of NNT and treatment adherence rates between different screening strategies.
Main Results:
- A multiple marker algorithm including PlGF is associated with a lower NNT (<30) compared to clinical factors alone.
- This algorithm demonstrates improved treatment adherence and facilitates personalized follow-up care.
- The combined approach offers a more comprehensive first-trimester risk assessment for preeclampsia.
Conclusions:
- A multiple marker screening algorithm, including PlGF, significantly enhances preterm preeclampsia risk assessment.
- Improved adherence and personalized care are key benefits of this advanced screening method.
- Offering this combined approach universally could optimize early detection and prevention strategies for preeclampsia.
Abstract:
Preterm preeclampsia, which affects 0.5%-1% of pregnancies, can be prevented with aspirin initiated before 16 weeks. However, its effectiveness is highly dependent on adherence. Screening for preterm preeclampsia based on clinical factors alone is associated with a high number needed to treat (>100) and poor treatment adherence. Conversely, a review of current evidence shows that a multiple marker algorithm including placental growth factor and standardized blood pressure measurement is associated with lower number needed to treat (<30) and improved treatment adherence and enables personalized follow-up care. Our review identifies that offering this combined approach to all pregnant persons could provide a more comprehensive first-trimester risk assessment for preeclampsia.

