Fetal Medicine Research Institute, King's College Hospital, London, UK.
Institute of Health Research, University of Exeter, Exeter, UK.
Ultrasound Obstet Gynecol. 2020 Jan;55(1):50-57. doi: 10.1002/uog.21867.
The traditional definition of pre-eclampsia (PE) is based on the development of hypertension and proteinuria. This has been revised recently to include cases without proteinuria but with evidence of renal, hepatic or hematological dysfunction. The aim of this study was to examine the impact of new definitions of PE on, first, the incidence and severity of the disease and, second, the performance of the competing-risks model for first-trimester assessment of risk for PE.
This was a retrospective study of 66 964 singleton pregnancies that were classified as having PE, gestational hypertension (GH) or no PE or GH, according to the traditional criteria of the International Society for the Study of Hypertension in Pregnancy (ISSHP-old), which defines PE as the presence of both hypertension and proteinuria. We reviewed the records of pregnancies with GH, and those cases with high creatinine or liver enzymes or low platelet count were reclassified as having PE, according to the new criteria of ISSHP (ISSHP-new) and the new criteria of the American College of Obstetricians and Gynecologists (ACOG). The groups of PE according to the traditional and new criteria were compared for, first, gestational age at delivery, birth-weight percentile and incidence of a small-for-gestational-age (SGA) neonate with birth weight < 10 percentile and perinatal death, and, second, the predictive performance for preterm PE of the competing-risks model based on the combination of maternal risk factors, uterine artery pulsatility index, mean arterial pressure and serum placental growth factor at 11-13 weeks' gestation (triple test).
According to ISSHP-old, 1870 (2.8%) cases had PE, 2182 (3.3%) had GH and 62 912 (94.0%) had no PE or GH. The incidence of PE according to ACOG was 3.0% (2029/66 964) and ISSHP-new was 3.4% (2301/66 964). Median gestational age at delivery in the extra cases of PE according to ACOG (difference, 1.3 weeks; 95% CI, 0.71-1.71 weeks) and in the extra cases of PE according to ISSHP-new (difference, 1.5 weeks; 95% CI, 1.29-1.71 weeks) was higher than in cases with PE according to ISSHP-old (38.4 weeks). The incidence of a SGA neonate in the extra cases of PE according to ACOG (relative risk, 0.57; 95% CI, 0.42-0.79) and in the extra cases of PE according to ISSHP-new (relative risk, 0.52; 95% CI, 0.42-0.65) was lower than in the cases of PE according to ISSHP-old (33.64%). In first-trimester screening for preterm PE by the triple test, the detection rate, at a 10% false-positive rate, was 75.9% (95% CI, 70.8-80.6%) for ISSHP-old, 74.3% (95% CI, 69.2-79.0%) for ACOG and 74.0% (95% CI, 68.9-78.6%) for ISSHP-new.
The new definitions of PE resulted in, first, an increase in pregnancies classified as having PE but the additional cases had milder disease, and, second, a non-significant decrease in the performance of first-trimester screening for PE. © 2019 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
子痫前期（PE）的传统定义基于高血压和蛋白尿的发展。最近已对此进行修订，包括无蛋白尿但有肾脏、肝脏或血液功能障碍证据的病例。本研究的目的是首先检查 PE 的新定义对疾病的发生率和严重程度的影响，其次是检查用于评估 PE 风险的第一孕期竞争风险模型的性能。
这是一项对 66964 例单胎妊娠的回顾性研究，根据国际妊娠高血压学会（ISSHP-old）的传统标准，这些妊娠被分类为患有 PE、妊娠期高血压（GH）或无 PE 或 GH，该标准将 PE 定义为同时存在高血压和蛋白尿。我们回顾了 GH 妊娠的记录，并根据 ISSHP（ISSHP-new）和美国妇产科医师学会（ACOG）的新标准，将高肌酐或肝酶或血小板计数低的病例重新分类为 PE。比较了传统和新标准下的 PE 组，首先是分娩时的胎龄、出生体重百分位和出生体重<第 10 百分位数的小于胎龄儿（SGA）新生儿的发生率和围产儿死亡，其次是基于母体危险因素、子宫动脉搏动指数、平均动脉压和 11-13 周妊娠时血清胎盘生长因子的竞争风险模型（三联试验）对早产 PE 的预测性能。
根据 ISSHP-old，1870 例（2.8%）患有 PE，2182 例（3.3%）患有 GH，62912 例（94.0%）无 PE 或 GH。根据 ACOG，PE 的发生率为 3.0%（2029/66964），ISSHP-new 为 3.4%（2301/66964）。根据 ACOG 和 ISSHP-new 额外病例的 PE 中位分娩时胎龄（差异分别为 1.3 周；95%CI，0.71-1.71 周）高于 ISSHP-old 病例（38.4 周）。根据 ACOG 和 ISSHP-new 额外病例的 SGA 新生儿发生率（相对风险分别为 0.57；95%CI，0.42-0.79 和 0.52；95%CI，0.42-0.65）低于 ISSHP-old 病例（33.64%）。在第一孕期通过三联试验筛查早产 PE 时，在 10%假阳性率下的检出率，ISSHP-old 为 75.9%（95%CI，70.8-80.6%），ACOG 为 74.3%（95%CI，69.2-79.0%），ISSHP-new 为 74.0%（95%CI，68.9-78.6%）。
PE 的新定义首先导致被分类为患有 PE 的妊娠增加，但额外的病例疾病较轻，其次是用于筛查 PE 的第一孕期模型的性能无显著下降。
