TY - JOUR
T1 - First-trimester prediction of preterm pre-eclampsia and prophylaxis by aspirin
T2 - Effect on spontaneous and iatrogenic preterm birth
AU - Nicolaides, Kypros H.
AU - Syngelaki, Argyro
AU - Poon, Liona C.
AU - Rolnik, Daniel L.
AU - Tan, Min Yi
AU - Wright, Alan
AU - Wright, David
N1 - Funding Information:
The Screening ProgRamme for prE‐Eclampsia (SPREE) study was supported by a grant from the National Institute for Health Research Efficacy and Mechanism Evaluation (NIHR EME) Programme (14/01/02) – an MRC and NIHR partnership. The aspirin for evidence‐based pre‐eclampsia prevention (ASPRE) trial, was supported by a grant from the European Union 7th Framework Programme – FP7‐HEALTH‐2013‐INNOVATION‐2 (ASPRE Project # 601852), The SPREE study, the ASPRE trial and this study were supported by grants from the Fetal Medicine Foundation (UK Charity No: 1037116). Reagents and equipment for the measurement of serum placental growth factor were provided free of charge by PRevvity (previously affiliated with PerkinElmer Inc.) and Thermo Fisher Scientific. These bodies had no involvement in the study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.
Publisher Copyright:
© 2023 John Wiley & Sons Ltd.
PY - 2024/3
Y1 - 2024/3
N2 - 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.
AB - 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.
KW - aspirin
KW - ASPRE trial
KW - competing risks model
KW - mean arterial pressure
KW - NICE guidelines
KW - placental growth factor
KW - pre-eclampsia
KW - preterm birth
KW - SPREE study
KW - uterine artery Doppler
UR - http://www.scopus.com/inward/record.url?scp=85173032245&partnerID=8YFLogxK
U2 - 10.1111/1471-0528.17673
DO - 10.1111/1471-0528.17673
M3 - Article
C2 - 37749709
AN - SCOPUS:85173032245
SN - 1470-0328
VL - 131
SP - 483
EP - 492
JO - BJOG: An International Journal of Obstetrics and Gynaecology
JF - BJOG: An International Journal of Obstetrics and Gynaecology
IS - 4
ER -