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Biomarker screening for pre-eclampsia ‘superior’ to NICE guidelines

Using biomarkers to screen for pre-eclampsia in the first trimester of pregnancy is superior to the NICE recommendation to screen based on maternal characteristics and history, a study has found.

Researchers found that the more sophisticated biomarker screening method identified more women who might go on to develop pre-eclampsia, and who could therefore benefit from taking prophylactic aspirin, than the method suggested in the NICE guidelines.

When the NICE guidelines were applied to the women, using only maternal characteristics and medical history to screen for pre-eclampsia, the detection rate for developing pre-eclampsia at any point during the pregnancy was just over 30% and around 40% for severe pre-eclampsia leading to preterm birth. The detection rates for these two outcomes rose to 43% and 83% respectively when biomarkers were also applied to the screening criteria.

The study, carried out by UK researchers, looked at just over 16,700 pregnancies, recording maternal characteristics and medical history between 11 and 13 weeks gestation and also biophysical and biochemical markers such as mean arterial pressure and serum placental growth factor.

The authors suggest that the additional tests needed to include biomarkers in pre-eclampsia screening could be carried out during routine ultrasounds and blood tests and so would not add an extra time burden to medical staff, although there would be an added cost for the reagents used.

Dr Liona Poon, a gynaecologist and lecturer at King’s College London, and co-author of the paper, said: ‘The SPREE study has demonstrated that the performance of first trimester screening for pre-eclampsia by a combination of maternal factors and biomarkers is superior to that achieved by the method recommended by the current NICE guidelines.

‘We have provided definitive proof to support risk-based screening for preterm pre-eclampsia using various biomarkers. It is now time to revise the professional guidelines and to move away from using a checklist-based method for screening’.

Ultrasound Obstet Gynecol 2018; available online 14 March