OC13.02: Implementation of first trimester screening and prevention of pre‐eclampsia: a stepped wedge cluster‐randomised trial in Asia

This trial aimed to assess the efficacy, acceptability and safety of a first trimester screen-and-prevent strategy for preterm pre-eclampsia (PE). This was a multicentre cluster stepped wedge randomised trial (SWT) involving 48,725 pregnant women in ten regions across Asia from 2019 to 2022. The SWT started with a period where all recruiting centres provided routine antenatal care without any study-related intervention. At regular six-week intervals, one cluster was randomised to transit from non-intervention phase to intervention phase. In the intervention phase, women underwent first trimester FMF screening for preterm PE. Women who were identified as high-risk, with adjusted risk for preterm PE ≥ 1 in 100, received low-dose aspirin (LDA). Overall, 88.04% (42,897/48,725) of women agreed to undergo first trimester screening for preterm PE. Among those who were identified as high-risk in the intervention phase, 82.39% (2,919/3,543) received LDA. The use of LDA was significantly associated with a 41% reduction in the incidence of preterm PE (aOR 0.59; 95%CI 0.37-0.92). In additional, it correlated with 54%, 54%, 55% and 64% reduction in the incidence of PE <34 weeks (aOR 0.46; 95%CI 0.23-0.93), maternal composite adverse outcomes <34 weeks (aOR 0.46; 95%CI 0.27 to 0.81), spontaneous preterm birth <34 weeks (aOR 0.45; 95%CI 0.22-0.92) and perinatal death (aOR 0.34; 95%CI 0.12-0.91), respectively. There was no significant between-group difference in the incidence of severe adverse events due to LDA. The screen-and-prevent strategy for preterm PE is highly accepted among women from diverse ethnic backgrounds, beyond the original population where the strategy was developed. In the intervention phase, LDA effectively reduces the incidence of preterm PE and great obstetrical syndromes <34 weeks by approximately 50% among high-risk women. LDA is considered a safe intervention during pregnancy.

Authors

Institutions

Publication Details

Journal
Ultrasound in Obstetrics and Gynecology
Published
2024-09-01
DOI
https://doi.org/10.1002/uog.27809
Primary Topic
Pregnancy and preeclampsia studies
Type
article
Field-Weighted Citation Impact
0.00
Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

OC13.02: Implementation of first trimester screening and prevention of pre‐eclampsia: a stepped wedge cluster‐randomised trial in Asia

Kai Leong Chong, Y. Wah, Ho-fung Leung, Steven W. Shaw et al.
Ultrasound in Obstetrics and Gynecology
Pregnancy and preeclampsia studies
article

OC13.02: Implementation of first trimester screening and prevention of pre‐eclampsia: a stepped wedge cluster‐randomised trial in Asia

Kai Leong Chong, Y. Wah, Ho-fung Leung, Steven W. Shaw, L. Nguyen Hoang, Miao Zheng, Noppadol Chaiyasit, Ritsuko K. Pooh, Daljit Singh Sahota, Yali Hu, Zaleha Abdullah Mahdy, D. K. Gosavi, Raden Aditya Kusuma, Xinhui Lu, Tongta Nanthakomon, Richard Ma, Suchaya Luewan, Tien‐Chun Chang, Arihiro Shiozaki, Piengbulan Yapan, Diem Thi Nguyen, Nelson Lee, Shi Tai, Huan Liu, L.C. Poon, WC Leung, Miki Kaneko, Long Dinh, S. Lau, A.S. Aguilar
article en

Abstract

This trial aimed to assess the efficacy, acceptability and safety of a first trimester screen-and-prevent strategy for preterm pre-eclampsia (PE). This was a multicentre cluster stepped wedge randomised trial (SWT) involving 48,725 pregnant women in ten regions across Asia from 2019 to 2022. The SWT started with a period where all recruiting centres provided routine antenatal care without any study-related intervention. At regular six-week intervals, one cluster was randomised to transit from non-intervention phase to intervention phase. In the intervention phase, women underwent first trimester FMF screening for preterm PE. Women who were identified as high-risk, with adjusted risk for preterm PE ≥ 1 in 100, received low-dose aspirin (LDA). Overall, 88.04% (42,897/48,725) of women agreed to undergo first trimester screening for preterm PE. Among those who were identified as high-risk in the intervention phase, 82.39% (2,919/3,543) received LDA. The use of LDA was significantly associated with a 41% reduction in the incidence of preterm PE (aOR 0.59; 95%CI 0.37-0.92). In additional, it correlated with 54%, 54%, 55% and 64% reduction in the incidence of PE <34 weeks (aOR 0.46; 95%CI 0.23-0.93), maternal composite adverse outcomes <34 weeks (aOR 0.46; 95%CI 0.27 to 0.81), spontaneous preterm birth <34 weeks (aOR 0.45; 95%CI 0.22-0.92) and perinatal death (aOR 0.34; 95%CI 0.12-0.91), respectively. There was no significant between-group difference in the incidence of severe adverse events due to LDA. The screen-and-prevent strategy for preterm PE is highly accepted among women from diverse ethnic backgrounds, beyond the original population where the strategy was developed. In the intervention phase, LDA effectively reduces the incidence of preterm PE and great obstetrical syndromes <34 weeks by approximately 50% among high-risk women. LDA is considered a safe intervention during pregnancy.

Ultrasound in Obstetrics and GynecologyVol. 64(S1)
Thammasat University (TH), SHOWA Medical University (JP), Siriraj Hospital (TH), Chinese University of Hong Kong (HK), Kunming Medical University (CN), Kwong Wah Hospital (CN), Toyama College (JP), Philippine General Hospital (PH), King Chulalongkorn Memorial Hospital (TH), Chang Gung Memorial Hospital (TW), Hong Kong Jockey Club (HK), Guangzhou Women and Children Medical Center (CN), Nanjing Drum Tower Hospital (CN), Chinese University of Hong Kong, Shenzhen (CN), First Affiliated Hospital of Kunming Medical University (CN), Pembuluh Darah Harapan Kita (ID), Vietnam National Children's Hospital (VN), National University Hospital (SG), University of Toyama (JP), Chiang Mai University (TH), National University of Malaysia (MY), Guangzhou Medical University (CN)
Openalex Percentile: Top 76%
Pregnancy and preeclampsia studies
DOIOpen Access PDFOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.