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Implementación del cribado del primer trimestre basado en PlGF y la profilaxis con aspirina para la preeclampsia
1Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium.
Resumen
La implementación del cribado del factor de crecimiento placentario (PlGF) con la profilaxis de aspirina redujo significativamente las tasas de preeclampsia prematura y nacimientos prematuros. Esta estrategia de detección temprana también ofrece ahorros sustanciales en los costos de atención médica, apoyando una adopción más amplia.
Área de la Ciencia:
- Obstetricia y Ginecología.
- La medicina materno-fetal es una de ellas.
- Investigación de la eficacia clínica Investigación de la eficacia clínica.
Sus antecedentes:
- La preeclampsia prematura plantea riesgos significativos para la salud materna y neonatal.
- Los métodos actuales de detección de la preeclampsia prematura tienen limitaciones en la práctica de rutina.
- La detección temprana y la intervención son cruciales para mejorar los resultados.
Objetivo del estudio:
- Evaluar la eficacia clínica de un programa de cribado del primer trimestre utilizando el factor de crecimiento placentario (PlGF) seguido de una profilaxis con aspirina para prevenir la preeclampsia prematura.
- Evaluar el impacto económico de esta estrategia de detección y prevención en la atención obstétrica de rutina.
- Para determinar el impacto en las tasas generales de preeclampsia y nacimientos prematuros.
Principales métodos:
- Estudio de cohorte retrospectivo que compara las fases de preimplementación y postimplementación de una estrategia de detección y prevención.
- Evaluación de riesgos utilizando el algoritmo de riesgos competitivos de la Fundación de Medicina Fetal, con y sin PlGF.
- Profilaxis con aspirina (160 mg al día) administrada a embarazadas de alto riesgo hasta las 36 semanas de gestación.
- Análisis del resultado primario (preeclampsia prematura) y los resultados secundarios (nacimiento prematuro, preeclampsia general, costos de atención médica).
Principales resultados:
- La incidencia de la preeclampsia prematura disminuyó del 1,1% al 0,6% (aOR, 0,41).
- Las tasas generales de preeclampsia disminuyeron del 2,5% al 1,4% (aOR, 0,51), y las tasas de nacimientos prematuros del 5,9% al 4,7% (aOR, 0,76).
- Un algoritmo basado en PlGF mostró un efecto protector más pronunciado de la aspirina (aOR, 0.51).
- Se proyectan ahorros anuales de costos de 27.7 millones de euros a nivel nacional, evitando 403 casos de preeclampsia prematura.
Conclusiones:
- La implementación en el mundo real del cribado basado en PlGF con profilaxis de aspirina reduce efectivamente la preeclampsia prematura y el parto prematuro.
- La estrategia se asocia teóricamente con ahorros sustanciales en los costos del sistema de salud.
- Los hallazgos apoyan la adopción a nivel nacional de estrategias de detección y prevención tempranas para los trastornos hipertensivos del embarazo.
Palabras clave:
Aspirina para la profilaxis de la enfermedad.relación coste-efectividad.Pruebas de detección en el primer trimestre.política de salud materna política de salud materna.factor de crecimiento placentario.Preeclampsia pre-eclampsia prematura es una preeclampsia que ocurre antes del término del embarazo.
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