Comparison of diagnostic accuracy of early screening for pre‐eclampsia by NICE guidelines and a method combining maternal factors and biomarkers: results of SPREE

Tan, Min Yi; Wright, Dave; Syngelaki, Argyro; Akolekar, Ranjit; Cicero, S.; Janga, D.; Singh, Mandeep; Greco, Elena; Wright, Alan; Maclagan, Kate; Poon, Liona C.; Nicolaides, Kypros H.

doi:10.1002/uog.19039

Cited by 264 publications

(358 citation statements)

References 30 publications

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“…The performance of the combined screening model used for the ASPRE trial (maternal factors, mean arterial pressure, mean uterine artery PI, PlGF) was practically identical when applied to the dataset used for its development and the actual clinical trial 9,76 . In fact, this screening model was found to be considerably more efficient for the prediction of early PE than were the history-based screening policies recommended by both the American College of Obstetricians and Gynecologists and the UK National Institute for Health and Care Excellence 22,86 .…”

Section: Recommendationsmentioning

confidence: 95%

“…A 2008 meta‐analysis indicated that increased PI, alone or combined with notching, is the most predictive Doppler index for PE. A considerable amount of evidence published since then indicates the superiority of mean uterine artery PI as the preferred Doppler index for PE screening, and this is the index used for screening and prevention in the first trimester.…”

Section: Screening For Pre‐eclampsia Using Ultrasoundmentioning

confidence: 99%

See 1 more Smart Citation

ISUOG Practice Guidelines: role of ultrasound in screening for and follow‐up of pre‐eclampsia

Sotiriadis

Hernández‐Andrade

Costa

et al. 2018

Ultrasound in Obstet & Gyne

140

115

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RESUMEN Pautas de práctica de ISUOG: la función del ultrasonido en la detección y seguimiento de la preeclampsia Introducción La hipertensión en el embarazo afecta hasta el 10% de las mujeres embarazadas y la incidencia global combinada de la preeclampsia (PE) es de aproximadamente el 3%. Las diferencias significativas entre los países desarrollados y en desarrollo pueden atribuirse a diferencias reales o a diferencias derivadas de la adquisición de datos. La PE y sus complicaciones contribuyen en gran medida a la morbilidad y mortalidad materna y perinatal en todo el mundo. Dado que la atención oportuna y efectiva puede mejorar los resultados de la PE, el desarrollo de estrategias eficaces de predicción y prevención ha sido uno de los principales objetivos de la atención prenatal y de la investigación. La PE es una enfermedad multisistémica de origen multifactorial: está relacionada con placentación defectuosa, estrés oxidativo, autoinmunidad, activación de plaquetas y trombina, inflamación intravascular, disfunción endotelial, desequilibrio en la angiogénesis y mala adaptación cardíaca materna. La invasión defectuosa de la placenta está fuertemente asociada con la mayoría de los casos de PE temprana y grave. En contraste, la placentación defectuosa parece ser menos importante para el desarrollo de la PE que se manifiesta más tarde en el embarazo, por ejemplo después de las 34 semanas. En comparación con los embarazos afectados por la enfermedad de aparición temprana, en aquellos complicados con PE a término o cerca de este, la frecuencia de anomalías histológicas de las placentas es significativamente menor, y los factores maternos (p. ej. el síndrome metabólico o la hipertensión crónica) tienen una importancia relativamente mayor. También se observan diferencias entre la PE de aparición temprana y la de aparición tardía en los factores de riesgo, la capacidad de respuesta vascular materna, el rendimiento del cribado y la eficacia de la prevención. El conocimiento cada vez mayor sobre la fisiopatología de la PE se refleja en las estrategias de cribado actuales, que se basan en el historial, la demografía, los biomarcadores (como la presión arterial) y el Doppler de la arteria uterina. Actualmente hay más de 10 000 artículos de PubMed relacionados con la detección de la PE, lo que indica el gran interés en este tema. Menos de una quinta parte de estos se refieren a la detección temprana, lo que constituye un avance de la última década. El objetivo de estas Pautas es revisar la evidencia más reciente y, en lo posible, proporcionar recomendaciones basadas en la evidencia con respecto a la función del ultrasonido en el cribado y seguimiento de la PE. Las Pautas se centran en los aspectos técnicos y clínicos del cribado, sin incluir los aspectos económicos y políticos de la salud, como la conveniencia y la rentabilidad del cribado. Además, estas Pautas se elaboraron partiendo del supuesto de que se dispone de los recursos necesarios para la realización del cribado y el seguimiento (equipo, examinadores y conocimient...

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Section: Recommendationsmentioning

confidence: 95%

Section: Screening For Pre‐eclampsia Using Ultrasoundmentioning

confidence: 99%

ISUOG Practice Guidelines: role of ultrasound in screening for and follow‐up of pre‐eclampsia

Sotiriadis

Hernández‐Andrade

Costa

et al. 2018

Ultrasound in Obstet & Gyne

140

115

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“…Second, 2999 twin pregnancies (validation dataset) that were examined at five hospitals in England (King's College Hospital and Medway Maritime Hospital, between December 2015 and April 2018; Homerton University Hospital, between January 2014 and April 2018; North Middlesex University Hospital, between May 2015 and April 2018; and Southend University Hospital, between June 2015 and April 2018), one hospital in Bulgaria (Dr. Shterev Hospital in Sofia, between January 2013 and April 2018) and one hospital in Spain (Hospital Clínico Universitario Virgen de la Arrixaca in Murcia, between March 2009 and April 2018). Third, the validation dataset of 16 747 singleton pregnancies from the Screening ProgRamme for prE‐Eclampsia (SPREE) study; this was a prospective multicenter study in seven National Health Service (NHS) maternity hospitals in England. This study was approved by the NHS Research Ethics Committee in England and the Hospital Ethics Committees of the participating hospitals in Bulgaria and Spain.…”

Section: Methodsmentioning

confidence: 99%

Revised competing‐risks model in screening for pre‐eclampsia in twin pregnancy by maternal characteristics and medical history

Benkő

Chaveeva

Matallana

et al. 2019

Ultrasound in Obstet & Gyne

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Background We have proposed previously that the competing‐risks model for prediction of pre‐eclampsia (PE) based on maternal characteristics and medical history (prior model), developed in singleton pregnancies, can be extended to risk assessment for twins; in dichorionic (DC) and monochorionic (MC) twin pregnancies with the same characteristics as in singleton pregnancies, the distribution of gestational age at delivery with PE was shifted to the left by 8 and 10 weeks, respectively. However, in a subsequent validation study, we found that, in both the training and validation datasets, the observed incidence of PE was lower than the predicted one and such overestimation of risk was particularly marked for early PE. Objectives First, to develop a new extension of the competing‐risks prior model in screening for PE by maternal demographic characteristics and medical history in twin pregnancies in a training dataset. Second, to examine the predictive performance of this model in screening for PE with delivery < 34 weeks (early PE), < 37 weeks (preterm PE) and at any gestational age (all PE) in twins in a validation dataset. Third, to demonstrate the application of screening in a mixed population of singleton and twin pregnancies. Methods The data for this study were obtained from two prospective non‐intervention multicenter screening studies for PE in twin pregnancies at 11 + 0 to 13 + 6 weeks' gestation. The training and validation datasets consisted of 2219 and 2999 women, respectively. We used the training dataset to fit a model in which the effect of twins on shifting the distribution of gestational age at delivery with PE in singletons to the left should not be the same for all gestational ages but the shift should depend on the singleton prior mean; the effect increases with increasing prior mean. We examined the predictive performance of the model in the training and validation datasets using the area under the receiver–operating characteristics curve (AUC) and calibration plots. Data on 16 747 singleton pregnancies obtained from the Screening ProgRamme for prE‐Eclampsia (SPREE) study were included to examine the performance of screening in a mixed population of singleton and twin pregnancies. Results Calibration plots and calibration intercept and slope demonstrate superior predictive performance of the new model in the validation dataset. Although the AUC for twin pregnancies is lower than in singleton pregnancies, performance of screening in a mixed population of singleton and twin pregnancies is superior to that in singletons (AUC of 0.790 in a mixed population comprising 2% twins and 98% singletons compared to 0.775 in singletons). For the risk cut‐offs likely to be used in practice, all twin pregnancies screen positive using maternal characteristics and medical history. Conclusions A new competing‐risks model in screening for PE by maternal risk factors in twin pregnancy has been developed and, using this model, the predicted risks for early PE, preterm PE and all PE are in relatively good agr...

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“…The authors of a prospective multicentre study published in Ultrasound in Obstetrics & Gynecology said that using this alternative method could double the detection rate of preterm pre-eclampsia 1. When pre-eclampsia leads to preterm birth before 37 weeks’ gestation the risk for complications is particularly high.…”

mentioning

confidence: 99%

Use new screening test for early onset pre-eclampsia, say researchers

Wise¹

2018

BMJ

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Comparison of diagnostic accuracy of early screening for pre‐eclampsia by NICE guidelines and a method combining maternal factors and biomarkers: results of SPREE

Cited by 264 publications

References 30 publications

ISUOG Practice Guidelines: role of ultrasound in screening for and follow‐up of pre‐eclampsia

ISUOG Practice Guidelines: role of ultrasound in screening for and follow‐up of pre‐eclampsia

Revised competing‐risks model in screening for pre‐eclampsia in twin pregnancy by maternal characteristics and medical history

Use new screening test for early onset pre-eclampsia, say researchers

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