Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
J Obstet Gynaecol Res. 2022 Sep;48(9):2345-2352. doi: 10.1111/jog.15343. Epub 2022 Jun 24.
To evaluate the effectiveness of a preeclampsia (PE) screening program using the National Institute for Health and Care Excellence (NICE) guideline in pregnant Thai women.
A total of 2552 pregnancies received antenatal care and were delivered at Songklanagarind Hospital between November 2016 and April 2020. PE screening with the NICE guideline was used to identify mothers at risk. In cases of positive screening results, a daily dose of 81 mg aspirin was prescribed. Pregnancy outcomes were compared with 2783 participants who had maternity care before the implementation of the screening program. The effectiveness of aspirin prophylaxis following the NICE guideline was assessed by a logistic regression model to compare the risk of PE development between before and after guidance.
The screening positive rate by NICE was 8.3%. Of these, 77.36% of the participants received aspirin prophylaxis according to the NICE recommendation. After the implementation of the PE screening program, the incidence of PE slightly decreased (from 4.31% to 3.72%, p = 0.274). The chance of PE in pregnancies who had high-risk factors was reduced after using low-dose aspirin prophylaxis, even though the difference was not statistically significant.
Screening with the NICE guidelines followed by prescription of low-dose aspirin (81 mg/day) was probably not an effective strategy for the prevention of PE in our population. Combining biophysical and biochemical markers to identify pregnant women who subsequently develop PE, concurrently with an increased dose of aspirin prophylaxis, may provide a better outcome in clinical practice.
评估英国国家卫生与临床优化研究所（NICE）指南用于泰国孕妇子痫前期（PE）筛查的效果。
共有 2552 例妊娠在宋卡王子大学医院于 2016 年 11 月至 2020 年 4 月期间接受产前护理并分娩。使用 NICE 指南进行 PE 筛查，以识别有风险的母亲。对于筛查结果阳性的病例，开具每日 81mg 阿司匹林的处方。将妊娠结局与 2783 例在实施筛查项目前接受产科护理的参与者进行比较。通过逻辑回归模型评估 NICE 指南指导下阿司匹林预防的效果，比较指导前后 PE 发展的风险。
NICE 的筛查阳性率为 8.3%。其中，77.36%的参与者按照 NICE 建议接受了阿司匹林预防。实施 PE 筛查项目后，PE 的发生率略有下降（从 4.31%降至 3.72%，p=0.274）。尽管差异无统计学意义，但使用低剂量阿司匹林预防后，具有高危因素的妊娠发生 PE 的机会减少。
在我们的人群中，使用 NICE 指南进行筛查并开具低剂量阿司匹林（81mg/天）的处方可能不是预防 PE 的有效策略。结合生物物理和生物化学标志物来识别随后发生 PE 的孕妇，并同时增加阿司匹林预防的剂量，可能会在临床实践中提供更好的结果。
