{"id":99,"date":"2021-11-11T15:19:22","date_gmt":"2021-11-11T15:19:22","guid":{"rendered":"https:\/\/obgconnect.com\/senseclinical\/?p=99"},"modified":"2021-11-12T19:10:11","modified_gmt":"2021-11-12T19:10:11","slug":"results-from-the-spree-trial-how-does-first-trimester-preeclampsia-screening-compare-to-current-guidelines","status":"publish","type":"post","link":"https:\/\/obgconnect.com\/senseclinical\/2021\/11\/11\/results-from-the-spree-trial-how-does-first-trimester-preeclampsia-screening-compare-to-current-guidelines\/","title":{"rendered":"Results from the SPREE Trial: How Does First Trimester Preeclampsia Screening Compare to Current Guidelines?"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\">BACKGROUND AND PURPOSE:<\/h2>\n\n\n\n<ul class=\"wp-block-list\"><li>Current NICE guidelines use maternal characteristics and medical history to identify women at high risk for preeclampsia (PE) who could benefit from aspirin<\/li><li>NICE guideline considers a pregnant woman at high risk if<ul><li>Any one major factor<ul><li>History of hypertensive disease in previous pregnancy<\/li><li>Chronic kidney disease<\/li><li>Autoimmune disease<\/li><li>Diabetes mellitus<\/li><li>Chronic hypertension<\/li><\/ul><\/li><li><strong>OR<\/strong> any two moderate factors<ul><li>First pregnancy at age \u2265 40 years<\/li><li>Interpregnancy interval &gt; 10 years<\/li><li>BMI at first visit \u2265 35 kg\/m2<\/li><li>Family history of PE<\/li><\/ul><\/li><li>Using more traditional approach of professional committees, each factor is considered separately<\/li><li>Tan et al. (Ultrasound in Obstetrics &amp; Gynecology, 2018) compared the above NICE approach to screening PE to a method that uses Bayes\u2019 theorem that combines maternal factors with biomarkers<\/li><\/ul><\/li><\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">METHODS:<\/h2>\n\n\n\n<ul class=\"wp-block-list\"><li>Prospective multicenter cohort study<\/li><li>Screening program for pre-eclampsia (SPREE) study<\/li><li>Participants: Singleton pregnancies at 11\u201313 weeks&#8217; gestation had recording of maternal characteristics and medical history and measurements of<ul><li>Mean arterial pressure (MAP)<\/li><li>Uterine artery pulsatility index (UtA\u2010PI)<\/li><li>Serum placental growth factor (PlGF)<\/li><li>Serum pregnancy\u2010associated plasma protein\u2010A (PAPP\u2010A)<\/li><\/ul><\/li><li>The performance of screening for PE by the Bayes&#8217; theorem\u2010based method was compared with that of the NICE method<\/li><li>Primary outcome<ul><li>Detection rate (DR) using NICE method&nbsp;vs mini\u2010combined test (maternal factors, MAP and PAPP\u2010A) in the prediction of PE at any gestational age (all\u2010PE) for the same screen\u2010positive rate determined by the NICE method<\/li><\/ul><\/li><li>Secondary comparisons<ul><li>DR of screening recommended by the NICE guidelines&nbsp;vs&nbsp;3 Bayes&#8217; theorem\u2010based methods for prediction of preterm PE (requiring delivery &lt;37weeks)<ul><li>Maternal factors, MAP and PAPP\u2010A<\/li><li>Maternal factors, MAP and PlGF<\/li><li>Maternal factors, MAP, UtA\u2010PI and PlGF<\/li><\/ul><\/li><\/ul><\/li><\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">RESULTS:<\/h2>\n\n\n\n<ul class=\"wp-block-list\"><li>17,051 women were eligible and outcome data were obtained from 16,747<\/li><li>All-PE developed in 2.8% of the 16,747 pregnancies and preterm PE developed in 0.8%<\/li><li>NICE method for PE<ul><li>Screen positive rate: 10.3%<\/li><li>DR for all\u2010PE: 30.4%<\/li><li>DR for preterm PE: 40.8%<\/li><li>There was only 23% compliance with aspirin recommendation<\/li><\/ul><\/li><li>Mini-combined method for PE<ul><li>DR of the mini\u2010combined test for all\u2010PE was 42.5%<\/li><li>Superior to that of the NICE method by 12.1% (95% CI, 7.9\u201316.2%)<\/li><\/ul><\/li><li>Screening for preterm PE compared to NICE<ul><li>Maternal factors, MAP and PlGF: DR was 69.0%, which was superior to NICE method by 28.2% (95% CI, 19.4\u201337.0%)<\/li><li>Maternal factors, MAP, UtA\u2010PI and PlGF: DR was 82.4%, which was to NICE method by 41.6% (95% CI, 33.2\u201349.9%)<\/li><\/ul><\/li><\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">CONCLUSION:<\/h2>\n\n\n\n<ul class=\"wp-block-list\"><li>NICE detection rates and compliance were lower than using a Bayesian approach that incorporates serum markers<\/li><li>The authors state that a PE methodology that combines biomarkers with maternal factors is a substantial improvement over current recommendations<\/li><\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Learn More \u2013 Primary Sources:<\/h2>\n\n\n\n<p><a href=\"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/abs\/10.1002\/uog.19039\" target=\"_blank\" rel=\"noreferrer noopener\">Comparison of diagnostic accuracy of early screening for pre\u2010eclampsia by NICE guidelines and a method combining maternal factors and biomarkers: results of SPREE<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/fetalmedicine.org\/research\/assess\/preeclampsia\" target=\"_blank\" rel=\"noreferrer noopener\">Fetal Medicine Foundation Preeclampsia Risk Calculator<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>BACKGROUND AND PURPOSE: Current NICE guidelines use maternal characteristics and medical history to identify women at high risk for preeclampsia (PE) who could benefit from aspirin NICE guideline considers a pregnant woman at high risk if Any one major factor History of hypertensive disease in previous pregnancy Chronic kidney disease Autoimmune disease Diabetes mellitus Chronic [&hellip;]<\/p>\n","protected":false},"author":2423,"featured_media":137,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[27,28],"class_list":["post-99","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized","tag-pe","tag-preeclampsia"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Results from the SPREE Trial: How Does First Trimester Preeclampsia Screening Compare to Current Guidelines? - SENSE Clinical<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" 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