Screening for Preeclampsia and Fetal Growth Restriction in the First Trimester in Women without Chronic Hypertension

Piotr Tousty; Magda Fraszczyk-Tousty; Anna Golara; Adrianna Zahorowska; Michał Sławiński; Sylwia Dzidek; Hanna Jasiak-Jóźwik; Magda Nawceniak-Balczerska; Agnieszka Kordek; Ewa Kwiatkowska; Aneta Cymbaluk-Płoska; Andrzej Torbé; Sebastian Kwiatkowski

doi:10.3390/jcm12175582

Screening for Preeclampsia and Fetal Growth Restriction in the First Trimester in Women without Chronic Hypertension

J Clin Med. 2023 Aug 27;12(17):5582. doi: 10.3390/jcm12175582.

Affiliations

¹ Department of Gynecology and Obstetrics, Pomeranian Medical University, 70-111 Szczecin, Poland.
² Department of Neonatology and Neonatal Intensive Care, Pomeranian Medical University, 70-111 Szczecin, Poland.
³ Department of Laboratory Diagnostics, Public Clinical Hospital No. 2, 70-111 Szczecin, Poland.
⁴ Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University, 70-111 Szczecin, Poland.
⁵ Department of Reconstructive Surgery and Gynecological Oncology, Pomeranian Medical University, 70-111 Szczecin, Poland.

Abstract

Background: Nowadays, it is possible to identify a group at increased risk of preeclampsia (PE) and fetal growth restriction (FGR) using the principles of the Fetal Medicine Foundation (FMF). It has been established for several years that acetylsalicylic acid (ASA) reduces the incidence of PE and FGR in high-risk populations. This study aimed to evaluate the implementation of ASA use after the first-trimester screening in a Polish population without chronic hypertension, as well as its impact on perinatal complications.

Material and methods: A total of 874 patients were enrolled in the study during the first-trimester ultrasound examination. The risk of PE and FGR was assessed according to the FMF guidelines, which include the maternal history, mean arterial pressure (MAP), uterine artery pulsatility index (UtPI), pregnancy-associated plasma protein A (PAPP-A) and placental growth factor (PLGF). Among patients with a risk higher than >1:100, ASA was administered at a dose of 150 mg. Perinatal outcomes were assessed among the different groups.

Results: When comparing women in the high-risk group with those in the low-risk group, a statistically significantly higher risk of pregnancy complications was observed in the high-risk group. These complications included pregnancy-induced hypertension (PIH) (OR 3.6 (1.9-7)), any PE (OR 7.8 (3-20)), late-onset PE (OR 8.5 (3.3-22.4)), FGR or small for gestational age (SGA) (OR 4.8 (2.5-9.2)), and gestational diabetes mellitus type 1 (GDM1) (OR 2.4 (1.4-4.2)). The pregnancies in the high-risk group were more likely to end with a cesarean section (OR 1.9 (1.2-3.1)), while the newborns had significantly lower weights (<10 pc (OR 2.9 (1.2-6.9)), <3 pc (OR 10.2 (2.5-41.7))).

Conclusions: The first-trimester screening test for PE and FGR is a necessary and effective tool in identifying high-risk pregnancies. ASA prophylaxis among high-risk patients may have the most beneficial effect. Furthermore, this screening tool may significantly reduce the incidence of early-onset PE (eo-PE).

Keywords: aspirin; fetal growth restriction; first trimester; preeclampsia; screening.

Grants and funding

This research received no external funding.