ASPRE trial: Incidence of preterm pre-eclampsia in patients fulfilling ACOG and NICE criteria according to risk by FMF algorithm

L. C. Poon, D. L. Rolnik, M. Y. Tan, J. L. Delgado, T. Tsokaki, R. Akolekar, M. Singh, W. Andrade, T. Efeturk, J. C. Jani, W. Plasencia, G. Papaioannou, A. R. Blazquez, I. F. Carbone, D. Wright, K. H. Nicolaides

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objective: To report the incidence of preterm pre-eclampsia (PE) in women who are screen positive according to the criteria of the National Institute for Health and Care Excellence (NICE) and the American College of Obstetricians and Gynecologists (ACOG), and compare the incidence with that in those who are screen positive or screen negative by The Fetal Medicine Foundation (FMF) algorithm. Methods: This was a secondary analysis of data from the ASPRE study. The study population consisted of women with singleton pregnancy who underwent prospective screening for preterm PE by means of the FMF algorithm, which combines maternal factors and biomarkers at 11-13weeks' gestation. The incidence of preterm PE in women fulfilling the NICE and ACOG criteria was estimated; in these patients the incidence of preterm PE was then calculated in those who were screen negative relative to those who were screen positive by the FMF algorithm. Results: A total of 34573 women with singleton pregnancy delivering at ≥24weeks' gestation underwent prospective screening for preterm PE, of which 239 (0.7%) cases developed preterm PE. At least one of the ACOG criteria was fulfilled in 22287 (64.5%) pregnancies and the incidence of preterm PE was 0.97% (95% CI, 0.85-1.11%); in the subgroup that was screen positive by the FMF algorithm the incidence of preterm PE was 4.80% (95% CI, 4.14-5.55%), and in those that were screen negative it was 0.25% (95% CI, 0.18-0.33%), with a relative incidence in FMF screen negative to FMF screen positive of 0.051 (95% CI, 0.037-0.071). In 1392 (4.0%) pregnancies, at least one of the NICE high-risk criteria was fulfilled, and in this group the incidence of preterm PE was 5.17% (95% CI, 4.13-6.46%); in the subgroups of screen positive and screen negative by the FMF algorithm, the incidence of preterm PE was 8.71% (95% CI, 6.93-10.89%) and 0.65% (95% CI, 0.25-1.67%), respectively, and the relative incidence was 0.075 (95% CI, 0.028-0.205). In 2360 (6.8%) pregnancies fulfilling at least two of the NICE moderate-risk criteria, the incidence of preterm PE was 1.74% (95% CI, 1.28-2.35%); in the subgroups of screen positive and screen negative by the FMF algorithm the incidence was 4.91% (95% CI, 3.54-6.79%) and 0.42% (95% CI, 0.20-0.86%), respectively, and the relative incidence was 0.085 (95% CI, 0.038-0.192). Conclusion: In women who are screen positive for preterm PE by the ACOG or NICE criteria but screen negative by the FMF algorithm, the risk of preterm PE is reduced to within or below background levels. The results provide further evidence to support the personalized risk-based screening method that combines maternal factors and biomarkers.

Original languageEnglish
Pages (from-to)738-742
JournalUltrasound in Obstetrics and Gynecology
Volume51
Issue number6
DOIs
Publication statusPublished - 2018

Fingerprint

National Institutes of Health (U.S.)
Pre-Eclampsia
Medicine
Delivery of Health Care
Incidence
Pregnancy
Biomarkers
Mothers

Keywords

  • ACOG guidelines
  • Bayes' theorem
  • First-trimester screening
  • Mean arterial pressure
  • NICE guidelines
  • Placental growth factor
  • Pre-eclampsia
  • Pregnancy-associated plasma protein-A
  • Uterine artery Doppler

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Reproductive Medicine
  • Radiology Nuclear Medicine and imaging
  • Obstetrics and Gynaecology

Cite this

ASPRE trial : Incidence of preterm pre-eclampsia in patients fulfilling ACOG and NICE criteria according to risk by FMF algorithm. / Poon, L. C.; Rolnik, D. L.; Tan, M. Y.; Delgado, J. L.; Tsokaki, T.; Akolekar, R.; Singh, M.; Andrade, W.; Efeturk, T.; Jani, J. C.; Plasencia, W.; Papaioannou, G.; Blazquez, A. R.; Carbone, I. F.; Wright, D.; Nicolaides, K. H.

In: Ultrasound in Obstetrics and Gynecology, Vol. 51, No. 6, 2018, p. 738-742.

Research output: Contribution to journalArticle

Poon, LC, Rolnik, DL, Tan, MY, Delgado, JL, Tsokaki, T, Akolekar, R, Singh, M, Andrade, W, Efeturk, T, Jani, JC, Plasencia, W, Papaioannou, G, Blazquez, AR, Carbone, IF, Wright, D & Nicolaides, KH 2018, 'ASPRE trial: Incidence of preterm pre-eclampsia in patients fulfilling ACOG and NICE criteria according to risk by FMF algorithm', Ultrasound in Obstetrics and Gynecology, vol. 51, no. 6, pp. 738-742. https://doi.org/10.1002/uog.19019
Poon, L. C. ; Rolnik, D. L. ; Tan, M. Y. ; Delgado, J. L. ; Tsokaki, T. ; Akolekar, R. ; Singh, M. ; Andrade, W. ; Efeturk, T. ; Jani, J. C. ; Plasencia, W. ; Papaioannou, G. ; Blazquez, A. R. ; Carbone, I. F. ; Wright, D. ; Nicolaides, K. H. / ASPRE trial : Incidence of preterm pre-eclampsia in patients fulfilling ACOG and NICE criteria according to risk by FMF algorithm. In: Ultrasound in Obstetrics and Gynecology. 2018 ; Vol. 51, No. 6. pp. 738-742.
@article{da3db3c219354af29eb96fd56db47d41,
title = "ASPRE trial: Incidence of preterm pre-eclampsia in patients fulfilling ACOG and NICE criteria according to risk by FMF algorithm",
abstract = "Objective: To report the incidence of preterm pre-eclampsia (PE) in women who are screen positive according to the criteria of the National Institute for Health and Care Excellence (NICE) and the American College of Obstetricians and Gynecologists (ACOG), and compare the incidence with that in those who are screen positive or screen negative by The Fetal Medicine Foundation (FMF) algorithm. Methods: This was a secondary analysis of data from the ASPRE study. The study population consisted of women with singleton pregnancy who underwent prospective screening for preterm PE by means of the FMF algorithm, which combines maternal factors and biomarkers at 11-13weeks' gestation. The incidence of preterm PE in women fulfilling the NICE and ACOG criteria was estimated; in these patients the incidence of preterm PE was then calculated in those who were screen negative relative to those who were screen positive by the FMF algorithm. Results: A total of 34573 women with singleton pregnancy delivering at ≥24weeks' gestation underwent prospective screening for preterm PE, of which 239 (0.7{\%}) cases developed preterm PE. At least one of the ACOG criteria was fulfilled in 22287 (64.5{\%}) pregnancies and the incidence of preterm PE was 0.97{\%} (95{\%} CI, 0.85-1.11{\%}); in the subgroup that was screen positive by the FMF algorithm the incidence of preterm PE was 4.80{\%} (95{\%} CI, 4.14-5.55{\%}), and in those that were screen negative it was 0.25{\%} (95{\%} CI, 0.18-0.33{\%}), with a relative incidence in FMF screen negative to FMF screen positive of 0.051 (95{\%} CI, 0.037-0.071). In 1392 (4.0{\%}) pregnancies, at least one of the NICE high-risk criteria was fulfilled, and in this group the incidence of preterm PE was 5.17{\%} (95{\%} CI, 4.13-6.46{\%}); in the subgroups of screen positive and screen negative by the FMF algorithm, the incidence of preterm PE was 8.71{\%} (95{\%} CI, 6.93-10.89{\%}) and 0.65{\%} (95{\%} CI, 0.25-1.67{\%}), respectively, and the relative incidence was 0.075 (95{\%} CI, 0.028-0.205). In 2360 (6.8{\%}) pregnancies fulfilling at least two of the NICE moderate-risk criteria, the incidence of preterm PE was 1.74{\%} (95{\%} CI, 1.28-2.35{\%}); in the subgroups of screen positive and screen negative by the FMF algorithm the incidence was 4.91{\%} (95{\%} CI, 3.54-6.79{\%}) and 0.42{\%} (95{\%} CI, 0.20-0.86{\%}), respectively, and the relative incidence was 0.085 (95{\%} CI, 0.038-0.192). Conclusion: In women who are screen positive for preterm PE by the ACOG or NICE criteria but screen negative by the FMF algorithm, the risk of preterm PE is reduced to within or below background levels. The results provide further evidence to support the personalized risk-based screening method that combines maternal factors and biomarkers.",
keywords = "ACOG guidelines, Bayes' theorem, First-trimester screening, Mean arterial pressure, NICE guidelines, Placental growth factor, Pre-eclampsia, Pregnancy-associated plasma protein-A, Uterine artery Doppler",
author = "Poon, {L. C.} and Rolnik, {D. L.} and Tan, {M. Y.} and Delgado, {J. L.} and T. Tsokaki and R. Akolekar and M. Singh and W. Andrade and T. Efeturk and Jani, {J. C.} and W. Plasencia and G. Papaioannou and Blazquez, {A. R.} and Carbone, {I. F.} and D. Wright and Nicolaides, {K. H.}",
year = "2018",
doi = "10.1002/uog.19019",
language = "English",
volume = "51",
pages = "738--742",
journal = "Ultrasound in Obstetrics and Gynecology",
issn = "0960-7692",
publisher = "John Wiley and Sons Ltd",
number = "6",

}

TY - JOUR

T1 - ASPRE trial

T2 - Incidence of preterm pre-eclampsia in patients fulfilling ACOG and NICE criteria according to risk by FMF algorithm

AU - Poon, L. C.

AU - Rolnik, D. L.

AU - Tan, M. Y.

AU - Delgado, J. L.

AU - Tsokaki, T.

AU - Akolekar, R.

AU - Singh, M.

AU - Andrade, W.

AU - Efeturk, T.

AU - Jani, J. C.

AU - Plasencia, W.

AU - Papaioannou, G.

AU - Blazquez, A. R.

AU - Carbone, I. F.

AU - Wright, D.

AU - Nicolaides, K. H.

PY - 2018

Y1 - 2018

N2 - Objective: To report the incidence of preterm pre-eclampsia (PE) in women who are screen positive according to the criteria of the National Institute for Health and Care Excellence (NICE) and the American College of Obstetricians and Gynecologists (ACOG), and compare the incidence with that in those who are screen positive or screen negative by The Fetal Medicine Foundation (FMF) algorithm. Methods: This was a secondary analysis of data from the ASPRE study. The study population consisted of women with singleton pregnancy who underwent prospective screening for preterm PE by means of the FMF algorithm, which combines maternal factors and biomarkers at 11-13weeks' gestation. The incidence of preterm PE in women fulfilling the NICE and ACOG criteria was estimated; in these patients the incidence of preterm PE was then calculated in those who were screen negative relative to those who were screen positive by the FMF algorithm. Results: A total of 34573 women with singleton pregnancy delivering at ≥24weeks' gestation underwent prospective screening for preterm PE, of which 239 (0.7%) cases developed preterm PE. At least one of the ACOG criteria was fulfilled in 22287 (64.5%) pregnancies and the incidence of preterm PE was 0.97% (95% CI, 0.85-1.11%); in the subgroup that was screen positive by the FMF algorithm the incidence of preterm PE was 4.80% (95% CI, 4.14-5.55%), and in those that were screen negative it was 0.25% (95% CI, 0.18-0.33%), with a relative incidence in FMF screen negative to FMF screen positive of 0.051 (95% CI, 0.037-0.071). In 1392 (4.0%) pregnancies, at least one of the NICE high-risk criteria was fulfilled, and in this group the incidence of preterm PE was 5.17% (95% CI, 4.13-6.46%); in the subgroups of screen positive and screen negative by the FMF algorithm, the incidence of preterm PE was 8.71% (95% CI, 6.93-10.89%) and 0.65% (95% CI, 0.25-1.67%), respectively, and the relative incidence was 0.075 (95% CI, 0.028-0.205). In 2360 (6.8%) pregnancies fulfilling at least two of the NICE moderate-risk criteria, the incidence of preterm PE was 1.74% (95% CI, 1.28-2.35%); in the subgroups of screen positive and screen negative by the FMF algorithm the incidence was 4.91% (95% CI, 3.54-6.79%) and 0.42% (95% CI, 0.20-0.86%), respectively, and the relative incidence was 0.085 (95% CI, 0.038-0.192). Conclusion: In women who are screen positive for preterm PE by the ACOG or NICE criteria but screen negative by the FMF algorithm, the risk of preterm PE is reduced to within or below background levels. The results provide further evidence to support the personalized risk-based screening method that combines maternal factors and biomarkers.

AB - Objective: To report the incidence of preterm pre-eclampsia (PE) in women who are screen positive according to the criteria of the National Institute for Health and Care Excellence (NICE) and the American College of Obstetricians and Gynecologists (ACOG), and compare the incidence with that in those who are screen positive or screen negative by The Fetal Medicine Foundation (FMF) algorithm. Methods: This was a secondary analysis of data from the ASPRE study. The study population consisted of women with singleton pregnancy who underwent prospective screening for preterm PE by means of the FMF algorithm, which combines maternal factors and biomarkers at 11-13weeks' gestation. The incidence of preterm PE in women fulfilling the NICE and ACOG criteria was estimated; in these patients the incidence of preterm PE was then calculated in those who were screen negative relative to those who were screen positive by the FMF algorithm. Results: A total of 34573 women with singleton pregnancy delivering at ≥24weeks' gestation underwent prospective screening for preterm PE, of which 239 (0.7%) cases developed preterm PE. At least one of the ACOG criteria was fulfilled in 22287 (64.5%) pregnancies and the incidence of preterm PE was 0.97% (95% CI, 0.85-1.11%); in the subgroup that was screen positive by the FMF algorithm the incidence of preterm PE was 4.80% (95% CI, 4.14-5.55%), and in those that were screen negative it was 0.25% (95% CI, 0.18-0.33%), with a relative incidence in FMF screen negative to FMF screen positive of 0.051 (95% CI, 0.037-0.071). In 1392 (4.0%) pregnancies, at least one of the NICE high-risk criteria was fulfilled, and in this group the incidence of preterm PE was 5.17% (95% CI, 4.13-6.46%); in the subgroups of screen positive and screen negative by the FMF algorithm, the incidence of preterm PE was 8.71% (95% CI, 6.93-10.89%) and 0.65% (95% CI, 0.25-1.67%), respectively, and the relative incidence was 0.075 (95% CI, 0.028-0.205). In 2360 (6.8%) pregnancies fulfilling at least two of the NICE moderate-risk criteria, the incidence of preterm PE was 1.74% (95% CI, 1.28-2.35%); in the subgroups of screen positive and screen negative by the FMF algorithm the incidence was 4.91% (95% CI, 3.54-6.79%) and 0.42% (95% CI, 0.20-0.86%), respectively, and the relative incidence was 0.085 (95% CI, 0.038-0.192). Conclusion: In women who are screen positive for preterm PE by the ACOG or NICE criteria but screen negative by the FMF algorithm, the risk of preterm PE is reduced to within or below background levels. The results provide further evidence to support the personalized risk-based screening method that combines maternal factors and biomarkers.

KW - ACOG guidelines

KW - Bayes' theorem

KW - First-trimester screening

KW - Mean arterial pressure

KW - NICE guidelines

KW - Placental growth factor

KW - Pre-eclampsia

KW - Pregnancy-associated plasma protein-A

KW - Uterine artery Doppler

UR - http://www.scopus.com/inward/record.url?scp=85046436089&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85046436089&partnerID=8YFLogxK

U2 - 10.1002/uog.19019

DO - 10.1002/uog.19019

M3 - Article

AN - SCOPUS:85046436089

VL - 51

SP - 738

EP - 742

JO - Ultrasound in Obstetrics and Gynecology

JF - Ultrasound in Obstetrics and Gynecology

SN - 0960-7692

IS - 6

ER -