TY - JOUR
T1 - Diagnostic performance of first trimester screening of preeclampsia based on uterine artery pulsatility index and maternal risk factors in routine clinical use.
AU - Mönckeberg, Max
AU - Arias, Valentina
AU - Fuenzalida, Rosario
AU - Álvarez, Santiago
AU - Toro, Victoria
AU - Calvo, Andrés
AU - Kusanovic, Juan P.
AU - Monteiro, Lara J.
AU - Schepeler, Manuel
AU - Nien, Jyh K.
AU - Martinez, Jaime
AU - Illanes, Sebastián E.
N1 - Funding Information:
Funding: This work was supported by Universidad de los Andes.
Publisher Copyright:
© 2020 by the authors.
PY - 2020
Y1 - 2020
N2 - Preeclampsia is a pregnancy-specific disorder defined by new onset of hypertension and proteinuria after 20 weeks of gestation. The early detection of patients at risk of developing preeclampsia is crucial, however, predictive models are still controversial. We aim to evaluate the diagnostic performance of a predictive algorithm in the first trimester of pregnancy, in order to identify patients that will subsequently develop preeclampsia, and to study the effect of aspirin on reducing the rate of this complication in patients classified as high risk by this algorithm. A retrospective cohort including 1132 patients attending prenatal care at Clínica Dávila in Santiago, Chile, was conceived. The risk of developing preeclampsia (early and late onset) was calculated using algorithms previously described by Plasencia et al. Patients classified as high risk, in the first trimester of pregnancy, by these algorithms, were candidates to receive 100 mg/daily aspirin as prophylaxis at the discretion of the attending physician. The overall incidence of preeclampsia in this cohort was 3.5% (40/1132), and the model for early onset preeclampsia prediction detected 33% of patients with early onset preeclampsia. Among the 105 patients considered at high risk of developing preeclampsia, 56 received aspirin and 49 patients did not. Among those who received aspirin, 12% (7/56) developed preeclampsia, which is equal to the rate of preeclampsia (12% (6/49)) of those who did not receive this medication. Therefore, the diagnostic performance of an algorithm combining uterine artery Doppler and maternal factors in the first trimester predicted only one third of patients that developed preeclampsia. Among those considered at high risk for developing the disease using this algorithm, aspirin did not change the incidence of preeclampsia, however, this could be due either to the small study sample size or the type of the study, a retrospective, non-interventional cohort study.
AB - Preeclampsia is a pregnancy-specific disorder defined by new onset of hypertension and proteinuria after 20 weeks of gestation. The early detection of patients at risk of developing preeclampsia is crucial, however, predictive models are still controversial. We aim to evaluate the diagnostic performance of a predictive algorithm in the first trimester of pregnancy, in order to identify patients that will subsequently develop preeclampsia, and to study the effect of aspirin on reducing the rate of this complication in patients classified as high risk by this algorithm. A retrospective cohort including 1132 patients attending prenatal care at Clínica Dávila in Santiago, Chile, was conceived. The risk of developing preeclampsia (early and late onset) was calculated using algorithms previously described by Plasencia et al. Patients classified as high risk, in the first trimester of pregnancy, by these algorithms, were candidates to receive 100 mg/daily aspirin as prophylaxis at the discretion of the attending physician. The overall incidence of preeclampsia in this cohort was 3.5% (40/1132), and the model for early onset preeclampsia prediction detected 33% of patients with early onset preeclampsia. Among the 105 patients considered at high risk of developing preeclampsia, 56 received aspirin and 49 patients did not. Among those who received aspirin, 12% (7/56) developed preeclampsia, which is equal to the rate of preeclampsia (12% (6/49)) of those who did not receive this medication. Therefore, the diagnostic performance of an algorithm combining uterine artery Doppler and maternal factors in the first trimester predicted only one third of patients that developed preeclampsia. Among those considered at high risk for developing the disease using this algorithm, aspirin did not change the incidence of preeclampsia, however, this could be due either to the small study sample size or the type of the study, a retrospective, non-interventional cohort study.
KW - Aspirin
KW - Early prediction
KW - Gestational hypertension
KW - Predictive algorithm
KW - Preeclampsia
KW - Prenatal care
KW - Routine care
KW - Ultrasound
KW - Uterine artery Doppler
UR - http://www.scopus.com/inward/record.url?scp=85082796589&partnerID=8YFLogxK
U2 - 10.3390/diagnostics10040182
DO - 10.3390/diagnostics10040182
M3 - Article
AN - SCOPUS:85082796589
SN - 2075-4418
VL - 10
JO - Diagnostics
JF - Diagnostics
IS - 4
M1 - 182
ER -