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FMF triple test superior to ACOG and NICE recommendations for preeclampsia detection in Asian women

Natalia Reoutova
19 Nov 2019
From left: Prof Daljit Sihota, Prof Liona Poon, Prof Tay-Yeung Leung, Dr Piya Chaemsaithong

A study conducted by the Chinese University of Hong Kong (CUHK) demonstrated that the UK Fetal Medicine Foundation’s Bayes theorem-based model (FMF triple test) doubles the detection rate of preterm preeclampsia (PE) in Asian women vs current approach recommended by the American College of Obstetricians and Gynecologists (ACOG) and UK’s National Institute for Health and Care Excellence (NICE).

The FMF triple test uses mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI) and serum placental growth factor (PlGF) for PE detection. At fixed false-positive rates of 5 percent, 10 percent, 15 percent and 20 percent, the FMF triple test achieved PE detection rates of 48.2 percent, 64.0 percent, 71.8 percent and 75.8 percent, respectively. Meanwhile, screening using ACOG recommendations achieved a detection rate of 54.6 percent at 20.4 percent false-positive rate. At the same time, the detection rate using NICE guidelines was 26.3 percent at 5.5 percent false-positive rate. [Am J Obstet Gynecol 2019, doi: 10.1016/j.ajog.2019.09.041]

The prospective, non-intervention, multicentre study enrolled 10,935 women with singleton pregnancies at 11–13+6 weeks’ gestation across seven regions in Asia between December 2016 and June 2018. Of the study participants, 224 (2.05 percent) developed PE, including 73 cases (0.67 percent) of preterm PE.

“A minimum of 60 cases of preterm PE would be required for an alpha of 5 percent and a power of 80 percent [for statistical analysis]. The reported incidence of preterm PE in Asia is 0.6 percent. In order to obtain 60 cases of preterm PE, we needed to recruit 10,000 women,” explained the researchers. [PLoS One 2014;9:e100180]

PE complicates 2 percent to 5 percent of pregnancies and is a major cause of maternal and perinatal morbidity and mortality. [Semin Perinatol 2009;33:130-137; Am J Obstet Gynecol 2018;219:107.e1-.e6] The risk for such complications is particularly high when the disease is severe, leading to preterm birth at <37 weeks’ gestation (preterm PE). A systematic review and meta-analysis of 16 trials with a combined total of 18,907 participants reported that aspirin commenced before 16 weeks’ gestation at a dose of ≥100 mg reduced the risk of preterm PE by 65 percent. [Am J Obstet Gynecol 2018;218:287-293]

The traditional approach adopted by ACOG and NICE for identifying mothers-to-be who would benefit from aspirin PE treatment is based on maternal risk factors, such as history of PE in previous pregnancies, chronic hypertension, diabetes mellitus, renal disease, autoimmune disease, age ≥35 years, body mass index (BMI) >30 kg/m2, and family history of PE. However, recent evidence has demonstrated that such approach to screening is insufficient for predicting preterm PE. [Ultrasound Obstet Gynecol 2017;49:756-760]

“Based on a large number of women, this study has demonstrated that the FMF Bayes theorem-based model is effective in predicting preterm PE in an Asian population, and that this method of screening is superior to the approach recommended by ACOG and NICE,” wrote the researchers. “We have also shown that the FMF prediction model can be implemented as part of routine prenatal care through the use of existing infrastructure.”

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