TY - JOUR
T1 - Routine first trimester combined screening for preterm preeclampsia in Australia
T2 - A multicenter clinical implementation cohort study
AU - Rolnik, Daniel L
AU - Selvaratnam, Roshan J
AU - Wertaschnigg, Dagmar
AU - Meagher, Simon
AU - Wallace, Euan
AU - Hyett, Jon
AU - da Silva Costa, Fabricio
AU - McLennan, Andrew
N1 - Wertaschnigg: Ambulatorium für Fetalmedizin, Feldkirch, Austria
PY - 2022/9
Y1 - 2022/9
N2 - OBJECTIVE: To assess pregnancy outcomes following first trimester combined screening for preterm preeclampsia in Australia.METHODS: We compared pregnancy outcomes of women with singleton pregnancies who underwent first trimester combined preeclampsia screening with the Fetal Medicine Foundation algorithm between 2014 and 2017 in Melbourne and Sydney, Australia, with those from women who received standard care. The primary outcomes were preterm preeclampsia and screening performance. Effect estimates were presented as risk ratios with 95% confidence intervals.RESULTS: A total of 29 618 women underwent combined screening and 301 566 women received standard care. Women who had combined screening were less likely to have preeclampsia, preterm birth, small neonates, and low Apgar scores than the general population. Women with high-risk results (≥1 in 100) were more likely to develop preterm preeclampsia (2.1% vs. 0.7%, risk ratio [RR] 3.04, 95% CI 2.46-3.77), while low-risk women (risk <1 in 100) had lower rates of preterm preeclampsia (0.2% vs. 0.7%, RR 0.26, 95% CI 0.19-0.35) and other pregnancy complications. Screening detected 65.2% (95% CI 56.4-73.2%) of all preterm preeclampsia cases, with improved performance after adjustment for treatment effect.CONCLUSIONS: First trimester screening for preeclampsia in clinical practice identified a population at high risk of adverse pregnancy outcomes and low-risk women who may be suitable for less intensive antenatal care.
AB - OBJECTIVE: To assess pregnancy outcomes following first trimester combined screening for preterm preeclampsia in Australia.METHODS: We compared pregnancy outcomes of women with singleton pregnancies who underwent first trimester combined preeclampsia screening with the Fetal Medicine Foundation algorithm between 2014 and 2017 in Melbourne and Sydney, Australia, with those from women who received standard care. The primary outcomes were preterm preeclampsia and screening performance. Effect estimates were presented as risk ratios with 95% confidence intervals.RESULTS: A total of 29 618 women underwent combined screening and 301 566 women received standard care. Women who had combined screening were less likely to have preeclampsia, preterm birth, small neonates, and low Apgar scores than the general population. Women with high-risk results (≥1 in 100) were more likely to develop preterm preeclampsia (2.1% vs. 0.7%, risk ratio [RR] 3.04, 95% CI 2.46-3.77), while low-risk women (risk <1 in 100) had lower rates of preterm preeclampsia (0.2% vs. 0.7%, RR 0.26, 95% CI 0.19-0.35) and other pregnancy complications. Screening detected 65.2% (95% CI 56.4-73.2%) of all preterm preeclampsia cases, with improved performance after adjustment for treatment effect.CONCLUSIONS: First trimester screening for preeclampsia in clinical practice identified a population at high risk of adverse pregnancy outcomes and low-risk women who may be suitable for less intensive antenatal care.
KW - Cohort Studies
KW - Female
KW - Humans
KW - Infant, Newborn
KW - Pre-Eclampsia/diagnosis
KW - Pregnancy
KW - Pregnancy Complications/epidemiology
KW - Pregnancy Trimester, First
KW - Premature Birth/epidemiology
U2 - 10.1002/ijgo.14049
DO - 10.1002/ijgo.14049
M3 - Original Article
C2 - 34837224
SN - 0020-7292
VL - 158
SP - 634
EP - 642
JO - INTERNATIONAL JOURNAL OF GYNECOLOGY & OBSTETRICS
JF - INTERNATIONAL JOURNAL OF GYNECOLOGY & OBSTETRICS
IS - 3
ER -