Screening for Preeclampsia in the First Trimester and Aspirin Prophylaxis: Our First Year.

Inês Lourenço,Pedro Rocha,Helena Gomes,Carla Francisco,Joana Ribeiro,Filipa Caeiro

doi:10.1055/s-0040-1712124

Inês Lourenço, Pedro Rocha + Show 4 more

Open Access

https://doi.org/10.1055/s-0040-1712124

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Abstract

Preeclampsia is a major cause of perinatal and maternal morbidity and mortality. Our objective is to assess the performance of a combined screening test for preeclampsia in the first trimester and the prophylactic use of low-dose aspirin. Prospective study of all women attending our hospital for the first-trimester screening of aneuploidies, between March 2017 and February 2018 (n = 1,297). The exclusion criteria were multiple pregnancy and major fetal abnormalities. Preeclampsia screening was performed with an algorithm that includes maternal characteristics, and biophysical and biochemical biomarkers. High-risk was defined as a risk ≥ 1:50 of early-onset preeclampsia (before 34 weeks), in which cases low-dose aspirin (150 mg at night) was offered to these women from screening until 36 weeks. From the 1,272 enrolled participants, the majority were Caucasian (1,051; 82.6%) and multiparous (658, 51.7%). Fifty patients (3.9%) screened high-risk for preeclampsia, and all started a low-dose aspirin regimen, with good compliance (96%). Early-onset preeclampsia was found in 3 pregnant women (0.24%), and total preeclampsia was diagnosed in 25 (2.02%), compared with 28 (0.75%) cases of early preeclampsia (p = 0.0099) and 98 (2.62%) of total preeclampsia (p = 0.2904) before the implementation of screening. There was a lower incidence of both, early-onset and total preeclampsia, after the introduction of universal screening and prophylactic use of low-dose aspirin. This reduction was statistically significant in early-onset preeclampsia. The association of a first-trimester combined screening model and aspirin prophylaxis appears to be useful in predicting and reducing the incidence of early-onset preeclampsia, in a routine care setting.

Highlights

Preeclampsia (PE) affects 2 to 3% of all pregnancies, and, in developed countries, its incidence has increased in the last decades.[1,2,3,4,5] Preeclampsia is considered one of the most important causes of maternal and perinatal morbidity and mortality.[1,2,3,6,7] This condition is characterized by the development of new-onset high blood pressure after 20 weeks of gestation, with one or more of the following criteria: proteinuria, renal insufficiency, liver, neurological or hematological involvement, and fetal growth restriction.[8]
Early-onset preeclampsia was found in 3 pregnant women (0.24%), and total preeclampsia was diagnosed in 25 (2.02%), compared with 28 (0.75%) cases of early preeclampsia (p 1⁄4 0.0099) and 98 (2.62%) of total preeclampsia (p 1⁄4 0.2904) before the implementation of screening
There was a lower incidence of both, early-onset and total preeclampsia, after the introduction of universal screening and prophylactic use of low-dose aspirin. This reduction was statistically significant in early-onset preeclampsia

Summary

Introduction

Preeclampsia (PE) affects 2 to 3% of all pregnancies, and, in developed countries, its incidence has increased in the last decades.[1,2,3,4,5] Preeclampsia is considered one of the most important causes of maternal and perinatal morbidity and mortality.[1,2,3,6,7] This condition is characterized by the development of new-onset high blood pressure after 20 weeks of gestation, with one or more of the following criteria: proteinuria, renal insufficiency, liver, neurological or hematological involvement, and fetal growth restriction.[8] Preeclampsia is usually divided in early or late-onset preeclampsia, depending on whether the diagnosis is made before or after 34 weeks of gestation.[9,10,11] This classification is directly related to the prognosis, as early-onset PE is associated with more severe complications and adverse maternal and perinatal outcomes.[6,11,12,13,14] Early-onset PE has a lower incidence than late-onset PE, with a frequencies reported to be 0.5% and 1.4 to 1.7%, respectively.[5,6,14,15] Preeclampsia can be classified as preterm or term, according to whether delivery is needed before or after 37 weeks of gestation.[1,6,16]

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