A screening method for predicting preeclampsia based on the mother’s risk factors and biomarker measurements outperforms a standard method based only on maternal characteristics and medical history (Ultrasound Obstet Gynecol 2018; doi:10.1002/uog.19039).
The screening programme for preeclampsia (SPREE) study compared the standard preeclampsia screening method recommended by the U.K. National Institute for Health and Care Excellence (NICE) based only on maternal characteristics and medical history with a method that combines maternal risk factors and biomarker results. SPREE involved 16,747 women between 11 and 13 weeks’ gestation who were assessed at seven U.K. National Health Service maternity hospitals and in whom outcomes data were available. In all, 2.8% of participants developed preeclampsia; just 0.8% developed preterm preeclampsia, defined as requiring delivery before 37 weeks.
The new screening method being evaluated in SPREE included not only maternal characteristics but also measurement of different combinations of mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI), serum placental growth factor (PlGF), and serum pregnancy-associated plasma protein-A (PAPP-A).
The standard NICE-recommended method screened positive for 30.4% and 40.8% of all preeclampsia and preterm preeclampsia cases, respectively. In contrast, the new method combining maternal characteristics, MAP, and PAPP-A screened positive for 42.5% of all preeclampsia cases. Including PlGF and UtA-PI screened positive for 82.4% of all preterm preeclampsia cases.
“The SPREE study has provided definitive proof to support risk-based screening for preterm-[preeclampsia] using various biomarkers. It is now time to revise the professional guidelines and to move away from using a checklist-based method for screening,” said co-author Liona Poon, MD, clinical senior lecturer at King’s College London.
An online risk calculator using the SPREE screening method is available at www.fetalmedicine.org