Prediction and Prevention of Preeclampsia and Other Adverse Pregnancy Outcomes
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Aim
To assess current methods of prediction of adverse pregnancy outcomes, develop a
prediction model and assess diet and life style in preventing preeclampsia.
Methods
Meta-analyses performed to assess the role of abnormal 1st trimester biomarker levels
in predicting PE and the predictive accuracy of 2nd trimester UAD indices for stillbirth.
A prospective observational study was performed to assess the efficacy of maternal
characteristics, biomarkers, arteriography and UADs for predicting adverse pregnancy
outcomes. Previously published 1st trimester PE prediction models were validated
using data collected from the observational study. A systematic review on the effect of
diet and life style based metabolic risk modifying interventions on PE was performed.
Results
The review of biomarkers found that abnormal levels were particularIy associated with
early onset PE. The stillbirth review demonstrated a three-four fold increased risk of still
birth with abnormal UAD. 1045 women were included for analysis in the prospective
observational study. Our models’ detection rate (false positive rate of 15%) was 72%
for PE; 48% PIH; 30 % SGA <10th centile; 57% SGA <5th centile and 67% stillbirth.
In the validation study the observed discrimination ability in the derivation studies
ranged from 0.70 to 0.954. When validated against the study cohort, the AUC varied
importantly, ranging from 0.504 to 0.833. Dietary interventions were shown to reduce
the risk of PE by 33%, with no reduction in risk with mixed interventions or fatty acid
supplementation.
Conclusion
The high heterogeneity of studies in the systematic reviews makes it difficult to draw
firm conclusions regarding the use of biomarkers or UADs in screening for pregnancy
complications. Our prospective study showed a role for haemodynamics as part of
routine 1st trimester screening for assessing the risk of hypertensive disease in
pregnancy.
Authors
Allen, Rebecca EmmaCollections
- Theses [4144]