Institution: | 1. Department of Maternal and Fetal Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia;2. Department of Maternal and Fetal Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia
Faculty of Medicine, University of Newcastle, Newcastle, New South Wales, Australia;3. Ingham Institute for Applied Medical Research, Liverpool Hospital, Liverpool, New South Wales, Australia
Deprtment of Obstetrics and Gynaecology, Faculty of Medicine, Western Sydney University, Newcastle, New South Wales, Australia |
Abstract: | Objective Traditional obstetric practice relies 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 the clinical benefits of this approach, but widespread practice implementation has remained elusive. Methods We performed a systematic review and meta-analysis summarising studies linking first-trimester preeclampsia screening algorithms with the initiation of preventative therapy and examined their effect on pre-term preeclampsia rates compared with standard maternity care. Odds ratios were calculated together with 95% confidence intervals. Results 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 (odds ratio 0.61; 95% CI: 0.52–0.70). There were significant reductions in the prevalence of preeclampsia at <32–34 weeks, preeclampsia at any gestation and stillbirth. Conclusion First-trimester screening algorithms for preeclampsia aligned with early initiation of preventative therapy with aspirin reduce the prevalence of pre-term preeclampsia. |