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CC BY 4.0 · Rev Bras Ginecol Obstet 2020; 42(07): 390-396
DOI: 10.1055/s-0040-1712124
Original Article
High Risk Pregnancy
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

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

Rastreio de pré-eclâmpsia no primeiro trimestre e profilaxia com aspirina: O nosso primeiro ano
Inês Lourenço 
1   Department of Gynecology and Obstetrics, Hospital Beatriz Ângelo, Loures, Portugal
,
Helena Gomes 
1   Department of Gynecology and Obstetrics, Hospital Beatriz Ângelo, Loures, Portugal
,
Joana Ribeiro 
1   Department of Gynecology and Obstetrics, Hospital Beatriz Ângelo, Loures, Portugal
,
Filipa Caeiro 
1   Department of Gynecology and Obstetrics, Hospital Beatriz Ângelo, Loures, Portugal
,
Pedro Rocha 
1   Department of Gynecology and Obstetrics, Hospital Beatriz Ângelo, Loures, Portugal
,
Carla Francisco 
1   Department of Gynecology and Obstetrics, Hospital Beatriz Ângelo, Loures, Portugal
› Author Affiliations
Further Information

Publication History

08 October 2019

16 March 2020

Publication Date:
19 June 2020 (online)

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Abstract

Objective 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.

Methods 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.

Results 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.

Conclusion 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.

Resumo

Objetivo A pré-eclâmpsia é uma causa importante de morbi-mortalidade materna e perinatal. Os objetivos do nosso estudo foram avaliar a implementação do rastreio combinado de pré-eclâmpsia no primeiro trimestre e o uso profilático de aspirina em baixa dose.

Métodos Estudo prospetivo das mulheres referenciadas ao nosso hospital para realização do rastreio do primeiro trimestre de aneuploidias, entre março de 2017 e fevereiro de 2018 (n = 1.297). Os critérios de exclusão foram gravidez múltipla e anomalias fetais graves. O algoritmo usado no rastreio da pré-eclâmpsia combina características maternas, e marcadores biofísicos e bioquímicos. Definiu-se alto risco como risco de pré-eclâmpsia precoce (antes das 34 semanas) ≥ 1:50, tendo sido recomendada aspirina em baixa dose (150 mg à noite) desde o rastreio até às 36 semanas.

Resultados Das 1.272 participantes, a maioria era caucasiana (1.051; 82,6%) e multípara (658; 51,7%). Cinquenta grávidas (3,9%) foram consideradas de alto risco para pré-eclâmpsia e todas iniciaram aspirina em baixa dose, com boa adesão (96%). Pré-eclampsia precoce foi diagnosticada em 3 grávidas (0,24%), e no total foram diagnosticados 25 casos de pré-eclâmpsia (2,02%), comparativamente com 28 (0,75%) casos de pré-eclampsia precoces (p = 0,0099) e 98 (2,62%) casos totais de pré-eclâmpsia (p = 0,2904) observados antes da implementação do rastreio. Verificou-se uma menor incidência de pré-eclâmpsia precoce e total após introdução do rastreio universal e uso profilático de aspirina. A redução da pré-eclâmpsia precoce foi estatisticamente significativa.

Conclusão A associação de um modelo de rastreio combinado no primeiro trimestre com o uso profilático de aspirina é aparentemente eficaz na redução do risco de pré-eclâmpsia precoce.

Keywords

preeclampsia - first-trimester screening - aspirin

Palavras-chave

pré-eclâmpsia - rastreio primeiro trimestre - aspirina

Contributions

All the authors contributed equally to this paper, namely to the conception and design, data collection or analysis, and interpretation of data, writing of the article and review of the intellectual content. Therefore, all authors approved the final version to be published.


 

  • References

  • 1 O'Gorman N, Wright D, Syngelaki A, Akolekar R, Wright A, Poon LC, Nikolaides KH. Competing risks model in screening for preeclampsia by maternal factors and biomarkers at 11-13 weeks gestation. Am J Obstet Gynecol 2016; 214 (01) 103.e1-103.e12 . Doi: 10.1016/j.ajog.2015.08.034
    CrossrefPubMedSearch in Google Scholar
  • 2 Wright D, Syngelaki A, Akolekar R, Poon LC, Nicolaides KH. Competing risks model in screening for preeclampsia by maternal characteristics and medical history. Am J Obstet Gynecol 2015; 213 (01) 62.e1-62.e10 . Doi: 10.1016/j.ajog.2015.02.018
    CrossrefPubMedSearch in Google Scholar
  • 3 Phipps E, Prasanna D, Brima W, Jim B. Preeclampsia: updates in pathogenesis, definitions, and guidelines. Clin J Am Soc Nephrol 2016; 11 (06) 1102-1113 . Doi: 10.2215/CJN.12081115
    CrossrefPubMedSearch in Google Scholar
  • 4 Akolekar R, Syngelaki A, Poon L, Wright D, Nicolaides KH. Competing risks model in early screening for preeclampsia by biophysical and biochemical markers. Fetal Diagn Ther 2013; 33 (01) 8-15 . Doi: 10.1159/000341264
    CrossrefPubMedSearch in Google Scholar
  • 5 Poon LCY, Karagiannis G, Leal A, Romero XC, Nicolaides KH. Hypertensive disorders in pregnancy: screening by uterine artery Doppler imaging and blood pressure at 11-13 weeks. Ultrasound Obstet Gynecol 2009; 34 (05) 497-502 . Doi: 10.1002/uog.7439
    CrossrefPubMedSearch in Google Scholar
  • 6 Rolnik DL, Wright D, Poon LC, O'Gorman N, Syngelaki A, Matallana CP. , et al. Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia. N Engl J Med 2017; 377 (07) 613-622 . Doi: 10.1056/NEJMoa1704559
    CrossrefPubMedSearch in Google Scholar
  • 7 Roberge S, Nicolaides KH, Demers S, Villa P, Bujold E. Prevention of perinatal death and adverse perinatal outcome using low-dose aspirin: a meta-analysis. Ultrasound Obstet Gynecol 2013; 41 (05) 491-499 . Doi: 10.1002/uog.12421
    CrossrefPubMedSearch in Google Scholar
  • 8 Brown MA, Magee LA, Kenny LC, Karumanchi SA, McCarthy FP, Saito S. , et al; International Society for the Study of Hypertension in Pregnancy (ISSHP). The hypertensive disorders of pregnancy: ISSHP classification, diagnosis & management recommendations for international practice. Pregnancy Hypertens 2018; 13: 291-310 . Doi: 10.1016/j.preghy.2018.05.004
    CrossrefPubMedSearch in Google Scholar
  • 9 Tranquilli AL, Brown MA, Zeeman GG, Dekker G, Sibai BM. ; Statements from the International Society for the Study of Hypertension in Pregnancy (ISSHP). The definition of severe and early-onset preeclampsia. Pregnancy Hypertens 2013; 3 (01) 44-47 . Doi: 10.1016/j.preghy.2012.11.001
    CrossrefPubMedSearch in Google Scholar
  • 10 von Dadelszen P, Magee LA, Roberts JM. Subclassification of preeclampsia. Hypertens Pregnancy 2003; 22 (02) 143-148 . Doi: 10.1081/PRG-120021060
    CrossrefPubMedSearch in Google Scholar
  • 11 Lisonkova S, Joseph KS. Incidence of preeclampsia: risk factors and outcomes associated with early- versus late-onset disease. Am J Obstet Gynecol 2013; 209 (06) 544.e1-544.e12 . Doi: 10.1016/j.ajog.2013.08.019
    CrossrefPubMedSearch in Google Scholar
  • 12 Poon LC, Nicolaides KH. First-trimester maternal factors and biomarker screening for preeclampsia. Prenat Diagn 2014; 34 (07) 618-627 . Doi: 10.1002/pd.4397
    CrossrefPubMedSearch in Google Scholar
  • 13 Poon LC, Nicolaides KH. Early prediction of preeclampsia. Obstet Gynecol Int 2014; 2014: 297397 . Doi: 10.1155/2014/297397
    PubMedSearch in Google Scholar
  • 14 Bahado-Singh RO, Syngelaki A, Akolekar R, Mandal R, Bjondahl TC, Han B, Dong E. , et al. Validation of metabolomic models for prediction of early-onset preeclampsia. Am J Obstet Gynecol 2015; 213 (04) 530.e1-530.e10 . Doi: 10.1016/j.ajog.2015.06.044
    CrossrefPubMedSearch in Google Scholar
  • 15 Kongwattanakul K, Saksiriwuttho P, Chaiyarach S, Thepsuthammarat K. Incidence, characteristics, maternal complications, and perinatal outcomes associated with preeclampsia with severe features and HELLP syndrome. Int J Womens Health 2018; 10: 371-377 . Doi: 10.2147/IJWH.S168569
    CrossrefPubMedSearch in Google Scholar
  • 16 Johnson A, Federico C, Martinez M, Tran KA, Kao E, Hooshvar N. , et al. Term and preterm preeclampsia: are there two distinct phenotypes?. Pregnancy Hypertens 2015; 5 (01) 97 . Doi: 10.1016/j.preghy.2014.10.198
    PubMedSearch in Google Scholar
  • 17 Ogge G, Chaiworapongsa T, Romero R, Hussein Y, Kusanovic JP, Yeo L. , et al. Placental lesions associated with maternal underperfusion are more frequent in early-onset than in late-onset preeclampsia. J Perinat Med 2011; 39 (06) 641-652 . Doi: 10.1515/JPM.2011.098
    CrossrefPubMedSearch in Google Scholar
  • 18 Moldenhauer JS, Stanek J, Warshak C, Khoury J, Sibai B. The frequency and severity of placental findings in women with preeclampsia are gestational age dependent. Am J Obstet Gynecol 2003; 189 (04) 1173-1177 . Doi: 10.1067/s0002-9378(03)00576-3
    CrossrefPubMedSearch in Google Scholar
  • 19 Bujold E, Roberge S, Nicolaides KH. Low-dose aspirin for prevention of adverse outcomes related to abnormal placentation. Prenat Diagn 2014; 34 (07) 642-648 . Doi: 10.1002/pd.4403
    CrossrefPubMedSearch in Google Scholar
  • 20 Poon LCY, Syngelaki A, Akolekar R, Lai J, Nicolaides KH. Combined screening for preeclampsia and small for gestational age at 11-13 weeks. Fetal Diagn Ther 2013; 33 (01) 16-27 . Doi: 10.1159/000341712
    CrossrefPubMedSearch in Google Scholar
  • 21 Bujold E, Roberge S, Lacasse Y, Bureau M, Audibert F, Marcoux S. , et al. Prevention of preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy: a meta-analysis. Obstet Gynecol 2010; 116 (2 Pt 1): 402-414 . Doi: 10.1097/AOG.0b013e3181e9322a
    CrossrefPubMedSearch in Google Scholar
  • 22 Chaemsaithong P, Cuenca-Gomez D, Plana MN, Gil MM, Poon LC. Does low-dose aspirin initiated before 11 weeks' gestation reduce the rate of preeclampsia?. Am J Obstet Gynecol 2019; ;S0002-9378(19)31062-2; [Epub ahea d of print]
    CrossrefPubMedSearch in Google Scholar
  • 23 Caron N, Rivard GE, Michon N, Morin F, Pilon D, Moutquin JM, Rey É. Low-dose ASA response using the PFA-100 in women with high-risk pregnancy. J Obstet Gynaecol Can 2009; 31 (11) 1022-1027 . Doi: 10.1016/S1701-2163(16)34346-8
    CrossrefPubMedSearch in Google Scholar
  • 24 Homoncik M, Jilma B, Hergovich N, Stohlawetz P, Panzer S, Speiser W. Monitoring of aspirin (ASA) pharmacodynamics with the platelet function analyzer PFA-100. Thromb Haemost 2000; 83 (02) 316-321
    Thieme ConnectPubMedSearch in Google Scholar
  • 25 Poon LCY, Zymeri NA, Zamprakou A, Syngelaki A, Nicolaides KH. Protocol for measurement of mean arterial pressure at 11-13 weeks' gestation. Fetal Diagn Ther 2012; 31 (01) 42-48 . Doi: 10.1159/000335366
    CrossrefPubMedSearch in Google Scholar
  • 26 Robinson HP, Fleming JE. A critical evaluation of sonar “crown-rump length” measurements. Br J Obstet Gynaecol 1975; 82 (09) 702-710 . Doi: 10.1111/j.1471-0528.1975.tb00710.x
    CrossrefPubMedSearch in Google Scholar
  • 27 Plasencia W, Maiz N, Bonino S, Kaihura C, Nicolaides KH. Uterine artery Doppler at 11 + 0 to 13 + 6 weeks in the prediction of pre-eclampsia. Ultrasound Obstet Gynecol 2007; 30 (05) 742-749 . Doi: 10.1002/uog.5157
    CrossrefPubMedSearch in Google Scholar
  • 28 Kagan KO, Wright D, Spencer K, Molina FS, Nicolaides KH. First-trimester screening for trisomy 21 by free beta-human chorionic gonadotropin and pregnancy-associated plasma protein-A: impact of maternal and pregnancy characteristics. Ultrasound Obstet Gynecol 2008; 31 (05) 493-502 . Doi: 10.1002/uog.5332
    CrossrefPubMedSearch in Google Scholar
  • 29 O'Gorman N, Wright D, Poon LC, Rolnik DL, Syngelaki A, de Alvarado M. , et al. Multicenter screening for pre-eclampsia by maternal factors and biomarkers at 11-13 weeks' gestation: comparison with NICE guidelines and ACOG recommendations. Ultrasound Obstet Gynecol 2017; 49 (06) 756-760 . Doi: 10.1002/uog.17455
    CrossrefPubMedSearch in Google Scholar
  • 30 Roberge S, Villa P, Nicolaides K, Giguère Y, Vainio M, Bakthi A. , et al. Early administration of low-dose aspirin for the prevention of preterm and term preeclampsia: a systematic review and meta-analysis. Fetal Diagn Ther 2012; 31 (03) 141-146 . Doi: 10.1159/000336662
    CrossrefPubMedSearch in Google Scholar