Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK.
Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK.
BJOG. 2021 Jan;128(2):149-156. doi: 10.1111/1471-0528.16361. Epub 2020 Jul 1.
Evaluate clinical effectiveness of the first trimester combined (FMF) pre-eclampsia screening programme when implemented in a public healthcare setting.
Retrospective cohort study.
London tertiary hospital from January 2017 to March 2019.
7720 women screened for pre-eclampsia according to National Institute for Health and Care Excellence (NICE) risk-based guidance and 4841 by the Fetal Medical Foundation (FMF) algorithm which combined maternal risk factors, blood pressure, PAPP-A and uterine artery Doppler indices in the first trimester. High risk was defined by standard NICE criteria in the pre-intervention cohort (prescribed 75 mg aspirin) or a risk of ≥1:50 for preterm pre-eclampsia from the FMF algorithm in the post-intervention cohort (prescribed 150 mg aspirin).
Screening effectiveness, rates of pre-eclampsia.
The FMF screening programme resulted in a significant reduction in the screen-positive rate (16.1 versus 8.2%, odds ratio [OR] 0.50, 95% confidence interval [CI] 0.41-0.53) with a concurrent increase in targeted aspirin use in women classified as high risk for pre-eclampsia (28.9 versus 99.0%, OR 241.6, 95% CI 89.6-652.0). Screening indices were uniformly improved for the FMF algorithm with receiver operating characteristic (ROC) analysis demonstrating excellent discrimination for preterm pre-eclampsia (area under the curve [AUC] = 0.846, 95% CI 0.778-0.915, P value <.001). Interrupted time series analysis showed that the FMF screening programme resulted in a significant 21-month relative effect reduction of 80% (P = .025) and 89% (P = .017), for preterm and early pre-eclampsia, respectively.
First trimester combined screening for pre-eclampsia is both feasible and effective in a public healthcare setting. Such an approach results in a two-fold de-escalation of risk, doubling of pre-eclampsia detection, near total physician compliance of aspirin use and a significant reduction in the prevalence of preterm pre-eclampsia.
Implementation of 1st trimester combined pre-eclampsia screening effectively reduces prevalence of the disorder.
评估在公共医疗环境中实施第一孕期联合（FMF）子痫前期筛查方案的临床效果。
回顾性队列研究。
2017 年 1 月至 2019 年 3 月期间，伦敦的一家三级医院。
7720 名妇女根据国家卫生与保健卓越研究所（NICE）基于风险的指南进行子痫前期筛查，4841 名妇女根据胎儿医学基金会（FMF）算法进行筛查，该算法将产妇危险因素、血压、PAPP-A 和子宫动脉多普勒指数结合在第一孕期。高危定义为干预前队列中的标准 NICE 标准（规定服用 75 毫克阿司匹林）或干预后队列中 FMF 算法预测的早产子痫前期风险≥1:50（规定服用 150 毫克阿司匹林）。
筛查效果、子痫前期发生率。
FMF 筛查方案显著降低了筛查阳性率（16.1%比 8.2%，比值比[OR]0.50，95%置信区间[CI]0.41-0.53），同时增加了高危子痫前期妇女使用阿司匹林的比例（28.9%比 99.0%，OR 241.6，95%CI 89.6-652.0）。FMF 算法的筛查指标均得到改善，接受者操作特征（ROC）分析显示对早产子痫前期具有极好的鉴别力（曲线下面积[AUC]0.846，95%CI 0.778-0.915，P<0.001）。中断时间序列分析显示，FMF 筛查方案使早产和早期子痫前期的相对效果分别显著降低了 80%（P=0.025）和 89%（P=0.017），持续 21 个月。
在公共医疗环境中，第一孕期联合子痫前期筛查既可行又有效。这种方法可使风险降低两倍，子痫前期的检出率提高一倍，几乎所有医生都能遵医嘱使用阿司匹林，早产子痫前期的患病率也显著降低。
第一孕期联合子痫前期筛查可有效降低该疾病的发生率。
