Do first-trimester screening algorithms for preeclampsia aligned to use of preventative therapies reduce the prevalence of pre-term preeclampsia: A systematic review and meta-analysis.

Abstract

Traditional obstetric practice has relied upon history-based assessment to screen for preeclampsia and guide preventative therapies but is hampered by low sensitivity, high false positive rates and low treatment rates. First-trimester screening algorithms represent the most efficacious approach for risk prediction and could target early initiation of aspirin to well-defined high-risk populations. A large randomised controlled trial has demonstrated clinical benefits of this approach, but widespread practice implementation has remained elusive. We performed a systematic review and meta-analysis summarising studies linking first-trimester preeclampsia screening algorithms with initiation of preventative therapy and examine their effect on pre-term preeclampsia rates compared with standard maternity care. Odds ratios were calculated together with 95% confidence intervals. 7 studies with a total of 377,790 participants were included. Within singleton populations, early initiation of aspirin in response to a high-risk screening algorithm result reduced the prevalence of pre-term preeclampsia by 39% compared with routine antenatal care (OR 0.61; 95% CI: 0.52-0.70). There were significant reductions in the prevalence of preeclampsia at <32 to 34 weeks, preeclampsia at any gestation and stillbirth. First-trimester screening algorithms for preeclampsia aligned with early initiation of preventative therapy with aspirin reduces the prevalence of pre-term preeclampsia. This article is protected by copyright. All rights reserved.