Clinical effectiveness of routine first‐trimester combined screening for pre‐eclampsia in Spain with the addition of placental growth factor

• Published in: Acta obstetricia et gynecologica Scandinavica 2023-12, Vol.102 (12), p.1711-1718
• Main Authors: Garcia‐Manau, Pablo, Bonacina, Erika, Serrano, Berta, Caamiña, Sara, Ricart, Marta, Lopez‐Quesada, Eva, Vives, Àngels, Lopez, Monica, Pintado, Elena, Maroto, Anna, Catalan, Sara, Dalmau, Marta, Del Barco, Ester, Hernandez, Alina, Miserachs, Marta, San Jose, Marta, Armengol‐Alsina, Mireia, Carreras, Elena, Mendoza, Manel
• Format: Article
• Language: English
• Subjects: aspirin; Biomarkers; Cohort Studies; Eclampsia; Female; Growth factors; Humans; Infant, Newborn; Medical screening; Original; Placenta; Placenta Growth Factor; placental growth factor; PlGF; Pre-Eclampsia - diagnosis; Pre-Eclampsia - prevention & control; Preeclampsia; Pregnancy; Pregnancy Trimester, First; Pregnancy-Associated Plasma Protein-A; Premature Birth - prevention & control; Prenatal care; pre‐eclampsia; Pulsatile Flow; Retrospective Studies; Risk Assessment - methods; Salicylic Acid; screening; Spain; Treatment Outcome; Uterine Artery - diagnostic imaging
• ISSN: 0001-6349; 1600-0412; 1600-0412
• DOI: 10.1111/aogs.14687

Introduction Pre‐eclampsia affects 2%–8% of pregnancies and is one of the leading causes of maternal and perinatal morbidity and mortality. First‐trimester screening using an algorithm that combines maternal characteristics, mean arterial blood pressure, uterine artery pulsatility index and biomarkers (pregnancy‐associated plasma protein‐A and placental growth factor) is the method that achieves a greater diagnostic accuracy. It has been shown that daily salicylic acid administration before 16 weeks in women at a high risk for pre‐eclampsia can reduce the incidence of preterm pre‐eclampsia. However, no previous studies have evaluated the impact of routine first‐trimester combined screening for pre‐eclampsia with placental growth factor after being implemented in the clinical practice. Material and methods This was a multicenter cohort study conducted in eight different maternities across Spain. Participants in the reference group were prospectively recruited between October 2015 and September 2017. Participants in the study group were retrospectively recruited between March 2019 and May 2021. Pre‐eclampsia risk was calculated between 11+0 and 13+6 weeks using the Gaussian algorithm combining maternal characteristics, mean arterial pressure, uterine arteries pulsatility index, pregnancy‐associated plasma protein‐A and placental growth factor. Patients with a risk greater than 1/170 were prescribed daily salicylic acid 150 mg until 36 weeks. Patients in the reference group did not receive salicylic acid during gestation. Results A significant reduction was observed in preterm pre‐eclampsia (OR 0.47; 95% CI: 0.30–0.73), early‐onset (