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ASPRE trial: performance of screening for preterm pre-eclampsia.

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2017-08-24

Authors

Rolnik, D L
Wright, D
Poon, L C Y
Syngelaki, A
O'Gorman, N
de Paco Matallana, C
Akolekar, R
Cicero, S
Janga, D
Singh, M

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Abstract

To examine the performance of screening for preterm and term pre-eclampsia (PE) in the study population participating in the ASPRE (Combined Multimarker Screening and Randomized Patient Treatment with Aspirin for Evidence-Based Preeclampsia Prevention) trial. This was a prospective first-trimester multicenter study on screening for preterm PE in 26 941 singleton pregnancies by means of an algorithm that combines maternal factors, mean arterial pressure, uterine artery pulsatility index and maternal serum pregnancy-associated plasma protein-A and placental growth factor at 11-13 weeks' gestation. Eligible women with an estimated risk for preterm PE of > 1 in 100 were invited to participate in a double-blind trial of aspirin (150 mg per day) vs placebo from 11-14 until 36 weeks' gestation, which showed that, in the aspirin group, the incidence of preterm PE was reduced by 62%. In the screened population, the detection rates (DRs) and false-positive rates (FPRs) for delivery with PE  1 in 100 were invited to participate in a double-blind trial of aspirin (150 mg per day) vs placebo from 11-14 until 36 weeks' gestation, which showed that, in the aspirin group, the incidence of preterm PE was reduced by 62%. In the screened population, the detection rates (DRs) and false-positive rates (FPRs) for delivery with PE  The study population of 25 797 pregnancies included 180 (0.7%) cases of preterm PE, 450 (1.7%) of term PE and 25 167 (97.6%) without PE. In combined first-trimester screening for preterm PE with a risk cut-off of 1 in 100, the DR was 76.7% (138/180) for preterm PE and 43.1% (194/450) for term PE, at screen-positive rate of 10.5% (2707/25 797) and FPR of 9.2% (2375/25 797). The performance of screening in the ASPRE study was comparable with that of a study of approximately 60 000 singleton pregnancies used for development of the algorithm; in that study, combined screening detected 76.6% of cases of preterm PE and 38.3% of term PE at a FPR of 10%. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

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MeSH Terms

Adult
Algorithms
Aspirin
Biomarkers
Double-Blind Method
Female
Humans
Mass Screening
Placenta Growth Factor
Platelet Aggregation Inhibitors
Pre-Eclampsia
Pregnancy
Pregnancy Trimester, First
Pregnancy-Associated Plasma Protein-A
Prospective Studies
Research Design
Uterine Artery
Young Adult

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Keywords

ASPRE trial, first-trimester screening, mean arterial pressure, placental growth factor, pre-eclampsia, pregnancy-associated plasma protein-A, pyramid of pregnancy care, uterine artery Doppler

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