Nicolaides Kypros H, Syngelaki Argyro, Poon Liona C, Rolnik Daniel L, Tan Min Yi, Wright Alan, Wright David
Fetal Medicine Research Institute, King's College Hospital, London, UK.
Institute of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK.
BJOG. 2024 Mar;131(4):483-492. doi: 10.1111/1471-0528.17673. Epub 2023 Sep 25.
To report the predictive performance for preterm birth (PTB) of the Fetal Medicine Foundation (FMF) triple test and National Institute for health and Care Excellence (NICE) guidelines used to screen for pre-eclampsia and examine the impact of aspirin in the prevention of PTB.
Secondary analysis of data from the SPREE study and the ASPRE trial.
Multicentre studies.
In SPREE, women with singleton pregnancies had screening for preterm pre-eclampsia at 11-13 weeks of gestation by the FMF method and NICE guidelines. There were 16 451 pregnancies that resulted in delivery at ≥24 weeks of gestation and these data were used to derive the predictive performance for PTB of the two methods of screening. The results from the ASPRE trial were used to examine the effect of aspirin in the prevention of PTB in the population from SPREE.
Comparison of performance of FMF method and NICE guidelines for pre-eclampsia in the prediction of PTB and use of aspirin in prevention of PTB.
Spontaneous PTB (sPTB), iatrogenic PTB for pre-eclampsia (iPTB-PE) and iatrogenic PTB for reasons other than pre-eclampsia (iPTB-noPE).
Estimated incidence rates of sPTB, iPTB-PE and iPTB-noPE were 3.4%, 0.8% and 1.6%, respectively. The corresponding detection rates were 17%, 82% and 25% for the triple test and 12%, 39% and 19% for NICE guidelines, using the same overall screen positive rate of 10.2%. The estimated proportions prevented by aspirin were 14%, 65% and 0%, respectively.
Prediction of sPTB and iPTB-noPE by the triple test was poor and poorer by the NICE guidelines. Neither sPTB nor iPTB-noPE was reduced substantially by aspirin.
报告胎儿医学基金会（FMF）三联检测法和用于子痫前期筛查的英国国家卫生与临床优化研究所（NICE）指南对早产（PTB）的预测性能，并研究阿司匹林在预防PTB中的作用。
对SPREE研究和ASPRE试验的数据进行二次分析。
多中心研究。
在SPREE研究中，单胎妊娠妇女在妊娠11 - 13周时采用FMF方法和NICE指南进行早产子痫前期筛查。共有16451例妊娠在妊娠≥24周时分娩，这些数据用于得出两种筛查方法对PTB的预测性能。ASPRE试验的结果用于研究阿司匹林在SPREE研究人群中预防PTB的效果。
比较FMF方法和NICE指南对子痫前期的预测性能以及阿司匹林在预防PTB中的应用。
自发性早产（sPTB）、子痫前期导致的医源性早产（iPTB - PE）以及子痫前期以外原因导致的医源性早产（iPTB - noPE）。
sPTB、iPTB - PE和iPTB - noPE的估计发病率分别为3.4%、0.8%和1.6%。三联检测法对应的检测率分别为17%、82%和25%，NICE指南对应的检测率分别为12%、39%和19%，两种方法的总体筛查阳性率均为10.2%。阿司匹林预防的估计比例分别为14%、65%和0%。
三联检测法对sPTB和iPTB - noPE的预测效果较差，NICE指南的预测效果更差。阿司匹林对sPTB和iPTB - noPE均未显著降低。
