From the Journals

Adding biomarkers beats NICE guidelines for detecting preeclampsia

 

Key clinical point: Screening for preeclampsia using the United Kingdom’s National Institute for Health and Care Excellence (NICE) guidelines only detects around one-third of all preeclampsia cases, but the addition of biomarkers can improve this significantly.

Major finding: The NICE guidelines detected 30.4% of cases of preeclampsia, while a Bayes’ theorem-based method using maternal risk factors and biomarkers detected 42.5%.

Data source: A prospective multicenter study of 16,747 singleton pregnancies.

Disclosures: The study was sponsored by King’s College London, and supported by the National Institute for Health Research Efficacy and Mechanism Evaluation Programme, the Fetal Medicine Foundation and NIHR Collaboration for Leadership in Applied Health Research and Care South London at King’s College Hospital NHS Foundation Trust, with in-kind support from PerkinElmer Life and Analytical Sciences, and Thermo Fisher Scientific. No conflicts of interest were declared.

Source: Tan MY et al. Ultrasound Obstet & Gynecol. 2018 Mar 14. doi: 10.1002/uog.19039.

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Screening for preeclampsia using the United Kingdom’s National Institute for Health and Care Excellence (NICE) guidelines detects only about one-third of cases, according to a study published in Ultrasound in Obstetrics & Gynecology.

The United Kingdom-based prospective multicenter study, involving 16,747 singleton pregnancies, also looked at the effectiveness of a screening method that used Bayes’ theorem to combine maternal risk factors with biomarkers.

Preeclampsia developed in 473 (2.8%) pregnancies, and in 142 cases (0.8%) this led to preterm birth.

The NICE method of screening labels as high-risk women who have one major risk factor – such as a history of hypertensive disease in pregnancy or chronic kidney disease – or two moderate factors, including first pregnancy older than 40 years or a family history of preeclampsia.

This method of screening detected 30.4% of the cases of preeclampsia that developed and 40.8% of the cases that resulted in pre-term birth. The overall screen-positive rate by the NICE method was 10.3% of all participants in the study (1,727 women).

The Bayes’ theorem-based method assessed maternal risk factors in combination with mean arterial pressure and serum pregnancy-associated plasma protein-A. The detection rate for all preeclampsia using this method was 42.5%, representing an improvement of 11.3% over the NICE method, after adjusting for the effects of aspirin use in both groups. Researchers also examined the effect of adding in the biomarkers of uterine artery pulsatility index and serum placental growth factor, and found this detected 82.4% of preterm preeclampsia.

“The performance of screening by a combination of maternal factors with biomarkers was far superior to that of screening by NICE guidelines,” wrote Min Yi Tan, MD, of King’s College Hospital in London, and co-authors.

Overall, 4.5% of women in the study took aspirin from 14 weeks’ gestation until 36 weeks or delivery, but only 23.2% of women who screened positive according to the NICE guidelines took aspirin.

“Such poor compliance may at least in part be attributed to the generally held belief, based on the results of a meta-analysis in 2007, that aspirin reduces the risk of PE by only about 10%,” Dr. Tan and co-authors wrote.

The authors acknowledged that their study did not explore the health economic implications of the combined screening approach, but said there was now accumulating evidence that the performance of first-trimester screening for preterm preeclampsia could be improved substantially by the additional measurement of biomarkers.

The study was sponsored by King’s College London, and supported by the National Institute for Health Research Efficacy and Mechanism Evaluation Programme, the Fetal Medicine Foundation and NIHR Collaboration for Leadership in Applied Health Research and Care South London at King’s College Hospital NHS Foundation Trust, with in-kind support from PerkinElmer Life and Analytical Sciences, and Thermo Fisher Scientific. No conflicts of interest were declared.

SOURCE: Tan MY et al. Ultrasound Obstet & Gynecol. 2018 Mar 14. doi: 10.1002/uog.19039.


 

FROM ULTRASOUND IN OBSTETRICS & GYNECOLOGY


Screening for preeclampsia using the United Kingdom’s National Institute for Health and Care Excellence (NICE) guidelines detects only about one-third of cases, according to a study published in Ultrasound in Obstetrics & Gynecology.
The United Kingdom-based prospective multicenter study, involving 16,747 singleton pregnancies, also looked at the effectiveness of a screening method that used Bayes’ theorem to combine maternal risk factors with biomarkers.


Preeclampsia developed in 473 (2.8%) pregnancies, and in 142 cases (0.8%) this led to preterm birth.
The NICE method of screening labels as high-risk women who have one major risk factor – such as a history of hypertensive disease in pregnancy or chronic kidney disease – or two moderate factors, including first pregnancy older than 40 years or a family history of preeclampsia.
This method of screening detected 30.4% of the cases of preeclampsia that developed and 40.8% of the cases that resulted in pre-term birth. The overall screen-positive rate by the NICE method was 10.3% of all participants in the study (1,727 women).


The Bayes’ theorem-based method assessed maternal risk factors in combination with mean arterial pressure and serum pregnancy-associated plasma protein-A. The detection rate for all preeclampsia using this method was 42.5%, representing an improvement of 11.3% over the NICE method, after adjusting for the effects of aspirin use in both groups. Researchers also examined the effect of adding in the biomarkers of uterine artery pulsatility index and serum placental growth factor, and found this detected 82.4% of preterm preeclampsia.
“The performance of screening by a combination of maternal factors with biomarkers was far superior to that of screening by NICE guidelines,” wrote Min Yi Tan, MD, of King’s College Hospital in London, and co-authors.

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