Do first‐trimester screening algorithms for preeclampsia aligned to use of preventative therapies reduce the prevalence of pre‐term preeclampsia: A systematic review and meta‐analysis

Abstract

AbstractObjectiveTraditional obstetric practice relies upon history‐based assessment to screen for preeclampsia and guide preventative therapies but is hampered by low sensitivity, high false‐positive rates and low treatment rates. First‐trimester screening algorithms represent the most efficacious approach for risk prediction and could target early initiation of aspirin to well‐defined high‐risk populations. A large randomised controlled trial has demonstrated the clinical benefits of this approach, but widespread practice implementation has remained elusive.MethodsWe performed a systematic review and meta‐analysis summarising studies linking first‐trimester preeclampsia screening algorithms with the initiation of preventative therapy and examined their effect on pre‐term preeclampsia rates compared with standard maternity care. Odds ratios were calculated together with 95% confidence intervals.Results7 studies with a total of 377,790 participants were included. Within singleton populations, early initiation of aspirin in response to a high‐risk screening algorithm result reduced the prevalence of pre‐term preeclampsia by 39% compared with routine antenatal care (odds ratio 0.61; 95% CI: 0.52–0.70). There were significant reductions in the prevalence of preeclampsia at <32–34 weeks, preeclampsia at any gestation and stillbirth.ConclusionFirst‐trimester screening algorithms for preeclampsia aligned with early initiation of preventative therapy with aspirin reduce the prevalence of pre‐term preeclampsia.