CRIFM Prenatal Medical Clinic, Osaka, Japan.
J Obstet Gynaecol Res. 2024 May;50(5):793-799. doi: 10.1111/jog.15908. Epub 2024 Feb 17.
Preeclampsia (PE) is a major maternal and fetal threat. Previous risk-scoring methods in guidelines lacked precision. The Fetal Medicine Foundation (FMF) proposed a first-trimester PE screening model using Bayes' theorem.
FMF prediction model combines maternal characteristics and medical/obstetrical history to determine prior risk and further incorporate maternal blood pressure, maternal serum biomarkers, and uterine Doppler pulsatility index expressed as multiples of the median (MoM) to estimate posterior risk.
LOW-DOSE ASPIRIN PREVENTION: Low-dose aspirin is one of the potential PE prevention strategies. Initiating it before 16 weeks is crucial. Aspirin's antiplatelet and anti-inflammatory properties align with PE's pathophysiology. Dosing and resistance warrant further study, but a standard regimen of 150 mg nightly, starting before 16 weeks, is widely supported.
Clinical trials, including ASPRE, affirm aspirin's role in PE prevention. Starting aspirin based on FMF screening significantly reduces preterm PE and associated complications.
Emerging research explores predictors like maternal ophthalmic arterial waveform. Regional variations, especially in Asian populations, are considered. Machine learning and AI show promise, but examiner expertise remains essential for accurate prediction. In conclusion, integrating FMF's first-trimester PE screening with low-dose aspirin offers a promising strategy. Further advancements may enhance precision and broaden prevention efforts.
子痫前期（PE）是一种主要的母婴威胁。之前的指南中的风险评分方法缺乏准确性。胎儿医学基金会（FMF）提出了一种使用贝叶斯定理的早期妊娠 PE 筛查模型。
PE 预测模型：FMF 预测模型结合了产妇特征和医疗/产科史，以确定先验风险，并进一步纳入母体血压、母体血清生物标志物和子宫多普勒搏动指数（表示为中位数倍数（MoM）），以估计后验风险。
低剂量阿司匹林是一种潜在的 PE 预防策略。在 16 周之前开始使用至关重要。阿司匹林的抗血小板和抗炎特性与 PE 的病理生理学一致。剂量和耐药性需要进一步研究，但广泛支持每晚 150 毫克、16 周前开始的标准方案。
PE 在实践中的预防：临床试验，包括 ASPRE，证实了阿司匹林在预防 PE 中的作用。基于 FMF 筛查开始使用阿司匹林可显著降低早产 PE 及其相关并发症的风险。
新的研究探索了像母体眼动脉波形这样的预测因子。考虑到区域差异，特别是在亚洲人群中。机器学习和人工智能显示出前景，但对于准确预测，检查者的专业知识仍然至关重要。总之，将 FMF 的早期妊娠 PE 筛查与低剂量阿司匹林结合使用提供了一种有前途的策略。进一步的进展可能会提高精度并扩大预防工作。
