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Selected medical society recommendations for preeclampsia prediction

Selected medical society recommendations for preeclampsia prediction
Consensus body Region Recommended screening criteria Gestational age Performance Advantages/disadvantages Comments
American College of Obstetricians and Gynecologists (ACOG)[1-4] US Historical/demographic risk factors only First prenatal visit (ideally first trimester) Detection rate:
  • Early PE (<32 weeks) ~50%
  • Preterm PE (<37 weeks) ~40 to 45%
  • Term PE (≥37 weeks) ~35%

Screen-positive rate ~10%
  • Applicable to all patients
  • Requires only assessment of historical/demographic factors that are readily attainable
  • Doesn't require access to Doppler ultrasonography or phlebotomy/laboratory testing
  • No added cost
  • Detection rate lower than multi-factor screening tests
  • Goal is: (i) to identify patients who will benefit from LDA prophylaxis to prevent preterm PE, and (ii) to stratify subsequent antenatal care
  • LDA reduces risk of preterm PE but not term PE, which represents the majority (80%) of PE cases
Society for Maternal Fetal Medicine (SMFM)[4] US Same as ACOG Same as ACOG Same as ACOG Same as ACOG  
National Institute for Health and Care Excellence (NICE)[5,6] UK Historical/demographic risk factors <10 weeks Same as ACOG Same as ACOG  
Fetal Medicine Foundation (FMF)[7,8] UK Optimal strategy: Historical/demographic risk factors + clinical exam/MAP + UTPI + biomarkers (PlGF, PAPP-A) 11 to 14 weeks Detection rate:
  • Early PE (<32 weeks) ~85 to 90%
  • Preterm PE (<37 weeks) ~70 to 75%
  • Term PE (≥37 weeks) ~40 to 50%

Screen-positive rate ~10%
  • Not available to all patients
  • Additional resources needed
  • Additional costs for blood tests and ultrasonography
  • Achieves higher detection rate for preterm PE
  • Associated with higher compliance with LDA prophylaxis
  • Does not accurately identify term PE, which represents the majority (80%) of cases
  • PlGF alone performs as well as combined PlGF plus PAPP-A
  • Detection rates are different in White versus Black populations (higher screen-positive rates in Black populations)
Low-resource setting: Historical/demographic risk factors + MAP 11 to 14 weeks Same as ACOG Same as ACOG  
International Federation of Gynecology and Obstetrics (FIGO)[9] Global Optimal strategy: Historical/demographic risk factors + clinical exam/MAP + UTPI + biomarkers (PlGF, PAPP-A) First trimester Same as FMF Same as FMF
Where not possible: Historical/demographic risk factors + MAP First trimester Same as ACOG Same as ACOG  
Society of Obstetricians and Gynaecologists of Canada (SOGC)[10] Canada At minimum: Clinical risk markers Early pregnancy Same as ACOG Same as ACOG  
If available: Clinical risk markers + UTPI + PlGF 11 to 14 weeks Same as FMF Same as FMF  
International Society of Ultrasound in Obstetrics and Gynecology (ISUOG)[11] Global Whenever possible, incorporate mean UTPI using transabdominal approach into combined screening with maternal factors + MAP + PlGF 11 to 13 weeks Detection rate:
  • Preterm PE (<37 weeks) ~75%
  • Term PE (≥37 weeks) ~45%

Screen-positive rate ~10%

 Same as FMF
  • Bilateral uterine artery notching in first trimester is nonspecific (seen in 43% of all pregnancies)
  • UTPI is not recommended as a stand-alone screening test
World Health Organization (WHO)[12] Global Same as ACOG Same as ACOG Same as ACOG    
For historical/demographic risk factors, refer to UpToDate table on high-risk and moderate-risk factors for developing preeclampsia.
LDA: low-dose aspirin; MAP: mean arterial pressure; PAPP-A: placenta-associated plasma protein-A; PE: preeclampsia; PlGF: placental growth factor; UTPI: uterine artery pulsatility index.
References:
  1. Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222. Obstet Gynecol 2020; 135:e237.
  2. ACOG Committee Opinion No. 743. Low-dose aspirin use during pregnancy. Obstet Gynecol 2018; 132:e44.
  3. US Preventive Services Task Force, Davidson KW, Barry MJ, et al. Aspirin use to prevent preeclampsia and related morbidity and mortality: US Preventive Services Task Force recommendation statement. JAMA 2021; 326:1186.
  4. American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine, Bryant AS, et al. Low-dose aspirin use for the prevention of preeclampsia and related morbidity and mortality. 2021 Available at: https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2021/12/low-dose-aspirin-use-for-the-prevention-of-preeclampsia-and-related-morbidity-and-mortality.
  5. PLGF-based testing to help diagnose suspected preterm pre-eclampsia. NICE Diagnostics Guidelines 49. July 2022. Available at: https://www.nice.org.uk/guidance/DG49/chapter/1-Recommendations (Accessed on October 13, 2023).
  6. Pre-eclampsia and hypertension in pregnancy. NICE Guideline [NG201]. August 2012. Available at: https://www.nice.org.uk/guidance/ng201/chapter/Recommendations#pre-eclampsia-and-hypertension-in-pregnancy (Accessed on October 13, 2023).
  7. Assessment of risk for preeclampsia (PE). Fetal Medicine Foundation. Available at: https://fetalmedicine.org/research/assess/preeclampsia/background (Accessed on October 13, 2023).
  8. Risk for preeclampsia. Fetal Medicine Foundation. Available at: https://fetalmedicine.org/research/assess/preeclampsia (Accessed on October 13, 2023).
  9. Poon LC, Shennan A, Hyett JA, et al. The International Federation of Gynecology and Obstetrics (FIGO) initiative on pre-eclampsia: A pragmatic guide for first-trimester screening and prevention. Int J Gynaecol Obstet 2019; 145 Suppl 1:1.
  10. Guideline No. 426: Hypertensive Disorders of Pregnancy: Diagnosis, Prediction, Prevention, and Management. J Obstet Gynecol Canada 2022; 44:547.
  11. ISUOG Practice Guidelines: Role of ultrasound in screening for and follow-up of preeclampsia. Ultrasound Obstet Gynecol 2019; 53:7.
  12. Conde-Agudelo A, Villar J, Lindheimer M. World Health Organization systematic review of screening tests for preeclampsia. Obstet Gynecol 2004; 104:1367.
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