Do first‐trimester screening algorithms for preeclampsia aligned to use of preventative therapies reduce the prevalence of pre‐term preeclampsia: A systematic review and meta‐analysis

Abstract

Objective Traditional obstetric practice relies upon history‐based assessment to screen for preeclampsia and guide preventative therapies but is hampered by low sensitivity, high false‐positive rates and low treatment rates. First‐trimester screening algorithms represent the most efficacious approach for risk prediction and could target early initiation of aspirin to well‐defined high‐risk populations. A large randomised controlled trial has demonstrated the clinical benefits of this approach, but widespread practice implementation has remained elusive. Methods We performed a systematic review and meta‐analysis summarising studies linking first‐trimester preeclampsia screening algorithms with the initiation of preventative therapy and examined their effect on pre‐term preeclampsia rates compared with standard maternity care. Odds ratios were calculated together with 95% confidence intervals. Results 7 studies with a total of 377,790 participants were included. Within singleton populations, early initiation of aspirin in response to a high‐risk screening algorithm result reduced the prevalence of pre‐term preeclampsia by 39% compared with routine antenatal care (odds ratio 0.61; 95% CI: 0.52–0.70). There were significant reductions in the prevalence of preeclampsia at <32–34 weeks, preeclampsia at any gestation and stillbirth. Conclusion First‐trimester screening algorithms for preeclampsia aligned with early initiation of preventative therapy with aspirin reduce the prevalence of pre‐term preeclampsia.

The first trimester: The new focal point for prenatal screening and diagnosis

“…In the 2011 issue, Kypros Nicolaides launched the concept of “ turning the pyramid of care .” First trimester preeclampsia screening in combination with low dose aspirin prophylaxis has been shown to be effective at reducing preterm preeclampsia in a systematic review provided for this issue 17 . Although the model for preeclampsia prediction using ultrasound maternal biomarkers in first trimester has gained huge success in the scientific community, translation into routine clinical practice has been much slower than the uptake of NIPT.…”

“…First trimester preeclampsia screening in combination with low dose aspirin prophylaxis has been shown to be effective at reducing preterm preeclampsia in a systematic review provided for this issue. 17 Although the model for preeclampsia prediction using ultrasound maternal biomarkers in first trimester has gained huge success in the scientific community, translation into routine clinical practice has been much slower than the uptake of NIPT. We are at an even earlier stage of translation of research findings into clinical practice in the field of congenital cytomegalovirus (CMV) infection.…”