Amylidi-Mohr Sofia, Kubias Jakub, Neumann Stefanie, Surbek Daniel, Risch Lorenz, Raio Luigi, Mosimann Beatrice
Department of Obstetrics and Gynaecology, University Hospital of Bern, University of Bern, Inselspital, Bern, Switzerland.
Division of Clinical Chemistry, Labormedizinisches Zentrum Dr. Risch, Bern, Switzerland.
Geburtshilfe Frauenheilkd. 2021 Jul 15;81(12):1354-1361. doi: 10.1055/a-1332-1437. eCollection 2021 Dec.
First trimester screening for preeclampsia (PE) is based on the combined risks model. Recent trials demonstrate that variations in multiple of the medians (MoMs) of the screening markers influence the performance of the algorithm in different populations. The aim of this study is to compare the performance of the algorithm in two cohorts with different prevention strategies. All first trimester screening tests performed between January 2014 and April 2020 were included. Up to June 2017 pregnancies with a risk > 1 : 200 for early-onset PE (eoPE) were considered at risk and received 100 mg of aspirin (strategy A). From July 2017 onwards, pregnancies with a risk > 1 : 100 for preterm PE (pPE) received 150 mg of aspirin (strategy B). We compared the screen positive rates (SPR) and incidence of PE between the two screening approaches. Statistical analysis were performed with Graphpad 8.0. 3552 pregnancies were included; 1577 pregnancies were screened according to strategy A, 1975 pregnancies according to strategy B. The screen positive rate (SPR) for strategy A and B was 8.9 and 16.9% respectively (p < 0.0001) while the incidence of PE was 1.41 and 1.84% respectively (p = ns). With a SPR of less than 10% we achieved a remarkably low rate of PE in our population, no further reduction in PE could be achieved by an increase in the SPR and LDA-prescription during the second screening period. The cut-off to define a pregnancy at risk for PE should be tailored to keep the SPR below 10% to avoid unnecessary treatment with aspirin.
早孕期子痫前期（PE）筛查基于联合风险模型。近期试验表明，筛查标志物中位数倍数（MoMs）的变化会影响该算法在不同人群中的表现。本研究的目的是比较该算法在两种采用不同预防策略队列中的表现。纳入了2014年1月至2020年4月期间进行的所有早孕期筛查测试。截至2017年6月，早发型PE（eoPE）风险>1:200的孕妇被视为高危孕妇，并接受100毫克阿司匹林治疗（策略A）。从2017年7月起，早产型PE（pPE）风险>1:100的孕妇接受150毫克阿司匹林治疗（策略B）。我们比较了两种筛查方法之间的筛查阳性率（SPR）和PE发病率。使用Graphpad 8.0进行统计分析。共纳入3552例妊娠；1577例妊娠根据策略A进行筛查，1975例妊娠根据策略B进行筛查。策略A和B的筛查阳性率（SPR）分别为8.9%和16.9%（p<0.0001），而PE发病率分别为1.41%和1.84%（p=无统计学意义）。在我们的人群中，SPR低于10%时，PE发生率极低，在第二次筛查期间增加SPR和低剂量阿司匹林（LDA）处方并不能进一步降低PE发生率。定义PE高危妊娠的临界值应进行调整，以使SPR保持在10%以下，以避免不必要的阿司匹林治疗。
