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Grand Rounds

Can Preterm Preeclampsia Screening Also Identify Women at Risk of Other Placental Complications?

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BACKGROUND AND PURPOSE:

  • Boutin et al. (AJOG, 2021) estimated the rate of placenta-mediated pregnancy complications in nulliparous women with a positive first-trimester FMF preterm preeclampsia screening test

METHODS:

  • Prospective cohort study
    • Secondary analysis of the Great Obstetrical Syndromes cohort study
  • Participants
    • Nulliparous women
    • 11w0d to 13w6d
  • Exposure
    • Positive or negative FMF algorithm test according to 2 risk cutoffs (1 in 70 and 1 in 100)
  • Study design
    • FMF algorithm inputs (based on the ASPRE study): Maternal characteristics | Mean arterial blood pressure | Maternal serum biomarkers | Mean uterine artery pulsatility index
    • Certain maternal characteristics were not available, including family history of preeclampsia or SLE
  • Primary outcomes
    • Test performance for preeclampsia, SGA of <10th percentile and <3rd percentile, and fetal death
    • Test performance for composite outcome of above complications
    • Test performance for severe composite outcome: Preterm PE, SGA of <3rd percentile, and intrauterine fetal death

RESULTS:

  • 4575 participants
    • Estimated risk of preterm preeclampsia of ≥1 in 70: 10.8%
    • Risk of ≥1 in 100: 15.9%
  • The test based on a risk cutoff of 1 in 70 could have correctly predicted the following, with a false positive rate of 10%
    • Preeclampsia: up to 27% of cases
    • Preterm preeclampsia: 55%
    • Small for gestational age: 18%
    • Severe small for gestational age: 24%
    • Fetal deaths: 37%
  • The test based on a cutoff of 1 in 100 could have predicted correctly the following, with a false positive rate of 15%
    • Preeclampsia: up to 35% of cases
    • Preterm preeclampsia: 69%
    • Small for gestational age: 25%
    • Severe small for gestational age: 30%
    • Fetal deaths: 53%
  • The positive predictive value of a screening test for preterm preeclampsia at a cutoff of ≥1 in 70
    • Preterm preeclampsia: 3%
    • Composite outcome: 32%
    • Severe composite outcome: 9%

CONCLUSION:

  • Nulliparous women who test “screen positive” on the FMF’s preterm preeclampsia screening test are at a higher risk of both preterm preeclampsia and other placental-mediated pregnancy complications
  • Approximately 1 in 10 women identified as at risk by the algorithm developed a placental-mediated complication

Learn More – Primary Sources:

Pregnancy outcomes in nulliparous women with positive first-trimester preterm preeclampsia screening test: the Great Obstetrical Syndromes cohort study

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Related ObG Topics:

ASPRE Trial: A Combined Risk Algorithm and Use of Aspirin to Prevent Preterm Preeclampsia
The FMF Model: Maternal Characteristics, Ultrasound and PlGF to Predict Preterm Preeclampsia
Does Aspirin for Preeclampsia Risk Reduction Affect Biomarkers or Fetal Growth?

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