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Preeclampsia Prevention by Timed Birth at Term

Most preeclampsia occurs at term. There are no effective preventative strategies. We aimed to identify the optimal preeclampsia screening and timing of birth strategy for prevention of term preeclampsia. METHODS: This secondary analysis was of data from a prospective nonintervention cohort study of...

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Autores principales: Magee, Laura A., Wright, David, Syngelaki, Argyro, von Dadelszen, Peter, Akolekar, Ranjit, Wright, Alan, Nicolaides, Kypros H.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10112937/
https://www.ncbi.nlm.nih.gov/pubmed/37035913
http://dx.doi.org/10.1161/HYPERTENSIONAHA.122.20565
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author Magee, Laura A.
Wright, David
Syngelaki, Argyro
von Dadelszen, Peter
Akolekar, Ranjit
Wright, Alan
Nicolaides, Kypros H.
author_facet Magee, Laura A.
Wright, David
Syngelaki, Argyro
von Dadelszen, Peter
Akolekar, Ranjit
Wright, Alan
Nicolaides, Kypros H.
author_sort Magee, Laura A.
collection PubMed
description Most preeclampsia occurs at term. There are no effective preventative strategies. We aimed to identify the optimal preeclampsia screening and timing of birth strategy for prevention of term preeclampsia. METHODS: This secondary analysis was of data from a prospective nonintervention cohort study of singleton pregnancies delivering at ≥24 weeks, without major anomalies, at 2 United Kingdom maternity hospitals. At routine visits at 11 to 13 weeks’ (57 131 pregnancies screened, 1138 term preeclampsia developed) or 35 to 36 weeks’ gestation (29 035 pregnancies screened, 619 term preeclampsia), with patient-specific preeclampsia risks determined by: United Kingdom National Institute for Health and Care Excellence guidance, and the Fetal Medicine Foundation competing-risks model. For each screening strategy, timing of birth for term preeclampsia prevention was evaluated at gestational time points that were fixed (37, 38, 39, 40 weeks) or dependent on preeclampsia risk by the competing-risks model at 35 to 36 weeks. Main outcomes were proportion of term preeclampsia prevented, and number-needed-to-deliver to prevent one term preeclampsia case. RESULTS: The proportion of term preeclampsia prevented was the highest, and number-needed-to-deliver lowest, for preeclampsia screening at 35 to 36 (rather than 11–13) weeks. For delivery at 37 weeks, fewer cases of preeclampsia were prevented for National Institute for Health and Care Excellence (28.8%) than the competing-risks model (59.8%), and the number-needed-to-deliver was higher (16.4 versus 6.9, respectively). The risk-stratified approach (at 35–36 weeks) had similar preeclampsia prevention (by 57.2%) and number-needed-to-deliver (8.4), but fewer women would be induced at 37 weeks (1.2% versus 8.8%). CONCLUSIONS: Risk-stratified timing of birth at term may more than halve the risk of term preeclampsia.
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spelling pubmed-101129372023-04-19 Preeclampsia Prevention by Timed Birth at Term Magee, Laura A. Wright, David Syngelaki, Argyro von Dadelszen, Peter Akolekar, Ranjit Wright, Alan Nicolaides, Kypros H. Hypertension Original Articles Most preeclampsia occurs at term. There are no effective preventative strategies. We aimed to identify the optimal preeclampsia screening and timing of birth strategy for prevention of term preeclampsia. METHODS: This secondary analysis was of data from a prospective nonintervention cohort study of singleton pregnancies delivering at ≥24 weeks, without major anomalies, at 2 United Kingdom maternity hospitals. At routine visits at 11 to 13 weeks’ (57 131 pregnancies screened, 1138 term preeclampsia developed) or 35 to 36 weeks’ gestation (29 035 pregnancies screened, 619 term preeclampsia), with patient-specific preeclampsia risks determined by: United Kingdom National Institute for Health and Care Excellence guidance, and the Fetal Medicine Foundation competing-risks model. For each screening strategy, timing of birth for term preeclampsia prevention was evaluated at gestational time points that were fixed (37, 38, 39, 40 weeks) or dependent on preeclampsia risk by the competing-risks model at 35 to 36 weeks. Main outcomes were proportion of term preeclampsia prevented, and number-needed-to-deliver to prevent one term preeclampsia case. RESULTS: The proportion of term preeclampsia prevented was the highest, and number-needed-to-deliver lowest, for preeclampsia screening at 35 to 36 (rather than 11–13) weeks. For delivery at 37 weeks, fewer cases of preeclampsia were prevented for National Institute for Health and Care Excellence (28.8%) than the competing-risks model (59.8%), and the number-needed-to-deliver was higher (16.4 versus 6.9, respectively). The risk-stratified approach (at 35–36 weeks) had similar preeclampsia prevention (by 57.2%) and number-needed-to-deliver (8.4), but fewer women would be induced at 37 weeks (1.2% versus 8.8%). CONCLUSIONS: Risk-stratified timing of birth at term may more than halve the risk of term preeclampsia. Lippincott Williams & Wilkins 2023-04-10 2023-05 /pmc/articles/PMC10112937/ /pubmed/37035913 http://dx.doi.org/10.1161/HYPERTENSIONAHA.122.20565 Text en © 2023 The Authors. https://creativecommons.org/licenses/by/4.0/Hypertension is published on behalf of the American Heart Association, Inc., by Wolters Kluwer Health, Inc. This is an open access article under the terms of the Creative Commons Attribution (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.
spellingShingle Original Articles
Magee, Laura A.
Wright, David
Syngelaki, Argyro
von Dadelszen, Peter
Akolekar, Ranjit
Wright, Alan
Nicolaides, Kypros H.
Preeclampsia Prevention by Timed Birth at Term
title Preeclampsia Prevention by Timed Birth at Term
title_full Preeclampsia Prevention by Timed Birth at Term
title_fullStr Preeclampsia Prevention by Timed Birth at Term
title_full_unstemmed Preeclampsia Prevention by Timed Birth at Term
title_short Preeclampsia Prevention by Timed Birth at Term
title_sort preeclampsia prevention by timed birth at term
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10112937/
https://www.ncbi.nlm.nih.gov/pubmed/37035913
http://dx.doi.org/10.1161/HYPERTENSIONAHA.122.20565
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