The
screening model combines maternal history, ultrasound data and several tests
for blood markers to enable personalised treatment.
Researchers
at the American Heart Association have developed a new screening algorithm for
preeclampsia which combines maternal history, ultrasound data and several tests
for blood markers. This could better predict most preeclampsia cases in the
first trimester of pregnancy, when it may still be preventable.
Preeclampsia
is the most dangerous form of high blood pressure during pregnancy, where blood
pressure measures ≥140/90 mm Hg. It is the leading cause of maternal death
worldwide, affecting one in 25 pregnancies in the US. More common in first-time
pregnancies, symptoms include headaches, vision changes and swelling of the mother’s
hands, feet, face or eyes, or a change in the well-being of the baby.
Furthermore, recent research has found that preeclampsia can be linked to an
increased risk of developing cardiovascular complications for women later in
life.
The
American College of Obstetricians and Gynecologists (ACOG) currently recommend
pregnant women to take aspirin if they have a major risk factor like chronic
high blood pressure, type 2 diabetes, chronic kidney disease, lupus or
preeclampsia in a prior pregnancy. Also, aspirin is recommended by ACOG for
pregnant women with two moderate risk factors such as being a black woman,
having a sister or mother with history of preeclampsia, having a first
pregnancy, obesity or an IVF pregnancy.
In
the new study, the team recruited over 7,554 women with first-time pregnancies
across Canada who were between 11 and 14 weeks pregnant to evaluate the Fetal
Medicine Foundation’s screening model. The model consisted of maternal history,
ultrasound data and numerous tests for blood markers. For participants between
11 and 13 weeks of pregnancy, the detection rate was 63.1 percent for preterm
preeclampsia and 77.3 percent for early preeclampsia (before 34 weeks of
gestation). The false positive rate was 15.8 percent.
Contrastingly,
using the risk factor-based guidelines from the ACOG, the detection rate for
preterm preeclampsia would be 61.5 percent, and 59.1 percent for early
preeclampsia. This would be with a false-positive rate of 34.3 percent, over
twice the false-positive rate of the Fetal Medicine Foundation’s screening
model.
Delivering
the baby is the only way to resolve preeclampsia once it has developed.
However, a previous meta-analysis by the study authors found that taking one
low-dose aspirin daily may reduce the risk of developing preeclampsia by up to
53 percent.
Dr
Emmaneul Bujold, professor in the department of obstetrics and gynecology at
the Université Laval in Québec City, commented: “Using this new screening
model, treatment decisions were based on each individual’s personal risk…With
their personal risk calculated, it’s much easier for a woman to make the right
decision, for example, if she chooses to take daily low-dose aspirin, she is
much more likely to follow through because it’s based on personalised screening
test.”
“It’s
reasonable to believe that the inclusion of the entire population and immediate
analysis of blood samples may both have improved the screening process. If we
implemented a screening programme in big cities across North America, the
screening would be expected to be even better and more accurate,” Dr Bujold
added.
Dr
Sadiya Khan, Magerstadt Professor of Cardiovascular Epidemiology, associate
professor of medicine and preventive medicine at the Northwestern University
Feinberg School of Medicine and preventive cardiologist at Northwestern
Medicine, explained: “Since the risks for preeclampsia may be largely
influenced by health before pregnancy, the ability of a screening model to be
applied in early pregnancy is very helpful and can initiate conversations
between the clinician and patient about strategies to optimise heart health.”
She
continued: “However, challenges remain with implementation of models such as
this one that integrate biomarkers that are not routinely assessed and may not
be widely available, especially among people in vulnerable populations who are
most likely to have the highest risk for preterm preeclampsia.”
This
study was published in Hypertension
World Journal of Case Reports and Clinical Images (ISSN 2835-1568)
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