Adverse pregnancy outcomes in women at increased risk of preterm pre‐eclampsia on first‐trimester combined screening

• Published in: BJOG : an international journal of obstetrics and gynaecology 2024-01, Vol.131 (1), p.81-87
• Main Authors: Minopoli, Monica, Noël, Laure, Meroni, Anna, Mascherpa, Margaret, Frick, Alex, Thilaganathan, Basky
• Format: Article
• Language: English
• Subjects: Birth; composite adverse outcomes of pregnancy; Eclampsia; Fetuses; first trimester; Placenta; Preeclampsia; Pregnancy; Premature birth; preterm birth; pre‐eclampsia; screening; small for gestational age; Stillbirth; uteroplacental dysfunction
• ISSN: 1470-0328; 1471-0528
• DOI: 10.1111/1471-0528.17560

Objective Uteroplacental dysfunction may not only result in pre‐eclampsia (PE) but also in preterm birth (PTB), small‐for‐gestational‐age (SGA) birth and stillbirth. The aim of this study is to evaluate the positive predictive value (PPV) of first‐trimester combined PE screening for all of these placenta‐mediated adverse pregnancy outcomes. Design Retrospective cohort study. Setting Tertiary referral maternity unit. Sample A total of 13 211 singleton pregnancies. Methods First‐trimester combined screening for preterm PE using the Fetal Medicine Foundation (FMF) algorithm. Main outcomes measures Hypertensive disorders of pregnancy (HDP), PTB, SGA birth and stillbirth were combined to assess composite adverse and severe adverse pregnancy outcomes (CAPO and CAPO‐S). The PPVs for CAPO and CAPO‐S were calculated for women with a combined risk for preterm PE of ≥1 in 50 and ≥1 in 100. Results First‐trimester combined screening identified 2215 women (16.8%) with a risk of ≥1 in 100 for preterm PE. The PPVs for a risk of ≥1 in 100 for CAPO and CAPO‐S were 38.8% and 18.2%, respectively. The equivalent PPVs for a risk of ≥1 in 50 were 45.1% and 21.1%, respectively. Conclusions Women identified at high risk of preterm PE are also at increased risk of other placenta‐mediated adverse pregnancy outcomes, such as PTB, SGA birth and stillbirth. Women at high risk for preterm PE after first‐trimester screening may benefit from a higher surveillance care pathway, with interventions to mitigate all the adverse outcomes associated with placental dysfunction.