Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China.
Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Ultrasound Obstet Gynecol. 2021 Oct;58(4):546-552. doi: 10.1002/uog.23668. Epub 2021 Sep 6.
To examine the possible risk factors amongst maternal characteristics, medical and obstetric history, pre-eclampsia (PE)-specific biomarkers and estimated-risk group, according to The Fetal Medicine Foundation (FMF) algorithm, that are associated with the development of preterm PE with delivery at < 37 weeks' gestation despite aspirin prophylaxis.
This was a secondary analysis of data from the ASPRE trial. The study population consisted of women with singleton pregnancy who were deemed to be at high risk for preterm PE, based on the FMF algorithm that combines maternal factors, mean arterial pressure, uterine artery pulsatility index, serum pregnancy-associated plasma protein-A and placental growth factor (PlGF) at 11-13 weeks' gestation. High-risk women were randomized to receive aspirin (150 mg/day) vs placebo from 11-14 until 36 weeks' gestation. The primary outcome was PE with delivery at < 37 weeks' gestation (preterm PE). Multivariate logistic regression analysis was performed to identify independent predictors of preterm PE after adjusting for the use of aspirin and other covariates.
Among 1592 high-risk women, the incidence of preterm PE was 3.0% (n = 48). The interaction between aspirin usage and history of chronic hypertension was significant in the prediction of preterm PE (P = 0.042), which indicated that there was no treatment effect in high-risk women who had chronic hypertension compared with those who did not. Adjusting for aspirin use, the interaction between aspirin and chronic hypertension and other covariates, independent predictors for the development of preterm PE were PlGF multiples of the median (MoM) (adjusted odds ratio (aOR), 0.226 (95% CI, 0.070-0.723)) and estimated-risk group based on the FMF algorithm. Compared to women with an estimated risk of 1 in 51 to 1 in 100, those with an estimated risk of 1 in 2 to 1 in 10 had a 7-fold higher risk of developing preterm PE (aOR, 6.706 (95% CI, 2.381-18.883)), and those with an estimated risk of 1 in 11 to 1 in 50 had a 3-fold higher risk of preterm PE (aOR, 2.769 (95% CI, 1.105-6.939)). PlGF MoM was an independent predictor for preterm PE among women with an estimated risk of 1 in 2 to 1 in 10 (aOR, 0.055 (95% CI, 0.005-0.668)). Among women with an estimated risk of 1 in 11 to 1 in 100, the use of aspirin was an independent predictor of preterm PE (aOR, 0.276 (95% CI, 0.111-0.689)). The cut-off for PlGF with the best performance for the prediction of preterm PE was 0.712 MoM, with an aOR of 3.677 (95% CI, 1.526-8.862).
In pregnancies at high risk of preterm PE identified by screening at 11-13 weeks' gestation using the FMF algorithm, a very high-risk result (estimated risk ≥ 1 in 50), compared to an estimated risk of 1 in 51 to 1 in 100, chronic hypertension, compared to no chronic hypertension, and low PlGF concentration (< 0.712 MoM), compared to PlGF ≥ 0.712 MoM, were associated with the development of preterm PE despite aspirin prophylaxis. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
根据胎儿医学基金会（FMF）算法，检查母体特征、医疗和产科病史、子痫前期（PE）特异性生物标志物和估计风险组中可能与早产 PE 发展相关的风险因素，这些因素与尽管使用阿司匹林预防但仍在 <37 周分娩有关。
这是 ASPRE 试验数据的二次分析。研究人群包括被认为有早产 PE 高风险的单胎妊娠妇女，根据 FMF 算法，该算法结合了母体因素、平均动脉压、子宫动脉搏动指数、11-13 周妊娠相关血浆蛋白 A 和胎盘生长因子（PlGF）。高危妇女随机接受阿司匹林（150mg/天）或安慰剂治疗，从 11-14 周至 36 周。主要结局是 <37 周分娩的 PE（早产 PE）。多变量逻辑回归分析用于确定调整阿司匹林使用和其他协变量后早产 PE 的独立预测因素。
在 1592 名高危妇女中，早产 PE 的发生率为 3.0%（n=48）。阿司匹林使用和慢性高血压病史之间的交互作用在预测早产 PE 中具有统计学意义（P=0.042），这表明与没有慢性高血压的高危妇女相比，慢性高血压妇女没有治疗效果。调整阿司匹林使用后，阿司匹林与慢性高血压的交互作用和其他协变量，早产 PE 的独立预测因素为 PlGF 中位数倍数（MoM）（调整后的优势比（aOR），0.226（95%CI，0.070-0.723））和基于 FMF 算法的估计风险组。与估计风险为 1/51 至 1/100 的妇女相比，估计风险为 1/2 至 1/10 的妇女发生早产 PE 的风险高 7 倍（aOR，6.706（95%CI，2.381-18.883）），估计风险为 1/11 至 1/50 的妇女发生早产 PE 的风险高 3 倍（aOR，2.769（95%CI，1.105-6.939））。PlGF MoM 是估计风险为 1/2 至 1/10 的妇女发生早产 PE 的独立预测因素（aOR，0.055（95%CI，0.005-0.668））。对于估计风险为 1/11 至 1/100 的妇女，阿司匹林的使用是早产 PE 的独立预测因素（aOR，0.276（95%CI，0.111-0.689））。预测早产 PE 的最佳性能 PlGF 截断值为 0.712 MoM，aOR 为 3.677（95%CI，1.526-8.862）。
在通过 11-13 周妊娠时使用 FMF 算法进行筛查确定的早产 PE 高危妊娠中，与估计风险为 1/51 至 1/100 相比，非常高的风险结果（估计风险≥1/50）、与无慢性高血压相比，慢性高血压、与 PlGF<0.712 MoM 相比，PlGF 浓度较低（<0.712 MoM）与尽管使用阿司匹林预防但仍在 <37 周分娩的早产 PE 相关。©2021 国际妇产科超声学会。
