Cost-utility of a first-trimester screening strategy versus the standard of care for nulliparous women to prevent pre-term pre-eclampsia in Belgium

Garcia, Ana Dubon; Devlieger, Roland; Redekop, Ken; Vandeweyer, Katleen; Verlohren, Stefan; Poon, Liona C.

doi:10.1016/j.preghy.2021.06.012

Cited by 13 publications

(8 citation statements)

References 36 publications

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“…Our data were compared to the Belgian (Flemish) general obstetric population. [29][30][31][32][33] Categorical data were presented as absolute frequencies or percentages and were compared using Pearson's Chisquared test or Fisher's Exact test or with binomial tests when only proportions were available. Distribution of continuous variables was assessed with the Shapiro-Wilks test.…”

Section: Discussionmentioning

confidence: 99%

What helps define outcomes in persistent uninterpretable non‐invasive prenatal testing: Maternal factors, fetal fraction or quality scores?

Lannoo,

Van Camp,

Brison

et al. 2023

Prenatal Diagnosis

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ObjectivesTo assess maternal characteristics and comorbidities in patients with persistent uninterpretable non‐invasive prenatal testing (NIPT) and to evaluate the association with adverse pregnancy outcome in a general risk population.MethodsA retrospective cohort study (July 2017–December 2020) was conducted of patients with persistent uninterpretable NIPT samples. Maternal characteristics and pregnancy outcomes were compared with the general Belgian obstetric population.ResultsOf the 148 patients with persistent uninterpretable NIPT, 37 cases were due to a low fetal fraction (LFF) and 111 due to a low quality score (LQS). Both groups (LFF, LQS) showed more obesity (60.6%, 42.4%), multiple pregnancies (18.9%, 4.5%) and more obstetrical complications. In the LQS group, a high rate of maternal auto‐immune disorders (30.6%) was seen and hypertensive complications (17.6%), preterm birth (17.6%) and neonatal intensive care unit (NICU) admission (22%) were significantly increased. In the LFF group hypertensive complications (21.6%), gestational diabetes (20.6%), preterm birth (27%), SGA (25.6%), major congenital malformations (11.4%), c‐section rate (51.4%) and NICU admission (34.9%) were significantly increased. Chromosomal abnormalities were not increased in both groups.ConclusionsPatients with persistent uninterpretable NIPT have significantly more maternal obesity, comorbidities and adverse pregnancy outcome than the general population and should receive high‐risk pregnancy care. Distinguishing between LFF and LQS optimizes counseling because maternal characteristics and pregnancy outcome differ between these groups.

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Section: Discussionmentioning

confidence: 99%

What helps define outcomes in persistent uninterpretable non‐invasive prenatal testing: Maternal factors, fetal fraction or quality scores?

Lannoo,

Van Camp,

Brison

et al. 2023

Prenatal Diagnosis

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“…Algorithms that aim to identify women at high risk of preeclampsia by clinical, biological, and ultrasound parameters have been published and have sparked enthusiasm, but the cost effectiveness of their implementation at a population level is still debated [ 25 – 28 ]. The trial was designed in 2008 and at the time, none of those algorithms were recommended which is why we selected our population differently.…”

Section: Discussionmentioning

confidence: 99%

Low-dose aspirin to prevent preeclampsia and growth restriction in nulliparous women identified by uterine artery Doppler as at high risk of preeclampsia: A double blinded randomized placebo-controlled trial

et al. 2022

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Introduction This trial evaluates whether daily low-dose aspirin initiated before 16 weeks of gestation can reduce preeclampsia and fetal growth restriction in nulliparous women identified by first-trimester uterine artery Dopplers as at high risk of preeclampsia. Methods This randomized, blinded, placebo-controlled, parallel-group trial took place in 17 French obstetric departments providing antenatal care. Pregnant nulliparous women aged ≥ 18 years with a singleton pregnancy at a gestational age < 16 weeks of gestation with a lowest pulsatility index ≥ 1.7 or a bilateral protodiastolic notching for both uterine arteries on an ultrasound performed between 11+0 and 13+6 weeks by a certified sonographer were randomized at a 1:1 ratio to 160 mg of low-dose aspirin or to placebo to be taken daily from inclusion to their 34th week of gestation. The main outcome was preeclampsia or a birthweight ≤ 5th percentile. Other outcomes included preeclampsia, severe preeclampsia, preterm preeclampsia, preterm delivery before 34 weeks, mode of delivery, type of anesthesia, birthweight ≤ 5th percentile and perinatal death. Results The trial was interrupted due to recruiting difficulties. Between June 2012 and June 2016, 1104 women were randomized, two withdrew consent, and two had terminations of pregnancies. Preeclampsia or a birthweight ≤ 5th percentile occurred in 88 (16.0%) women in the low-dose aspirin group and in 79 (14.4%) in the placebo group (proportion difference 1.6 [-2.6; 5.9] p = 0.45). The two groups did not differ significantly for the secondary outcomes. Conclusion Low-dose aspirin was not associated with a lower rate of either preeclampsia or birthweight ≤ 5th percentile in women identified by their first-trimester uterine artery Doppler as at high risk of preeclampsia. Trial registration (NCT0172946).

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“…Selv om preeklampsiforekomsten har vaert fallende i Norge (3), tilsier Folkehelseinstitu ets metodevurdering at en bedre screeningmetode vil kunne gi helseøkonomisk gevinst (1). De e samsvarer med studier fra andre land med god svangerskapsomsorg (7,8).…”

Section: «Selv Om Preeklampsiforekomsten Har Vaert Fallende I Norge T...unclassified

Ny og nyttig screening for preeklampsirisiko

Salvesen¹,

Staff²

2023

Tidsskriftet

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Kjell Åsmund Blix Salvesen er spesialist i fødselshjelp og kvinnesykdommer, seksjonsoverlege ved Kvinneklinikken, St. Olavs hospital og professor ved NTNU. Forfa eren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. Anne Cathrine Staff er spesialist i fødselshjelp og kvinnesykdommer, overlege og forskningsleder ved Kvinneklinikken, Oslo universitetssykehus og professor ved Universitetet i Oslo. Forfa eren har fylt ut ICMJE-skjemaet og oppgir følgende interessekonflikter: Hun har tidligere mo a forskningsstø e fra Roche Diagnostics, ikke relatert til screening i første trimester.En utvidelse av screeningprogrammet for gravide i første trimester er vurdert som helseøkonomisk lønnsomt og kan forhindre alvorlig sykdom og død.

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Cost-utility of a first-trimester screening strategy versus the standard of care for nulliparous women to prevent pre-term pre-eclampsia in Belgium

Cited by 13 publications

References 36 publications

What helps define outcomes in persistent uninterpretable non‐invasive prenatal testing: Maternal factors, fetal fraction or quality scores?

What helps define outcomes in persistent uninterpretable non‐invasive prenatal testing: Maternal factors, fetal fraction or quality scores?

Low-dose aspirin to prevent preeclampsia and growth restriction in nulliparous women identified by uterine artery Doppler as at high risk of preeclampsia: A double blinded randomized placebo-controlled trial

Ny og nyttig screening for preeklampsirisiko

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