Prediction and prevention of small-for-gestational-age neonates: evidence from SPREE and ASPRE

NMUH Staff Publications

<h4 style="font-size: 13px; margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; font-family: arial, helvetica, clean, sans-serif; text-align: left;"><span style="font-size: 10pt;">OBJECTIVE:</span></h4><p style="margin: 0px 0px 0.5em; font-size: 1.04em; font-family: arial, helvetica, clean, sans-serif; text-align: left;"><span style="font-size: 10pt;">To examine the effect of first trimester screening for preeclampsia (PE) on the prediction of small for gestational age (SGA) neonates and the effect of prophylactic use of aspirin on the prevention of SGA.</span></p><h4 style="font-size: 13px; margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; font-family: arial, helvetica, clean, sans-serif; text-align: left;"><span style="font-size: 10pt;">METHODS:</span></h4><p style="margin: 0px 0px 0.5em; font-size: 1.04em; font-family: arial, helvetica, clean, sans-serif; text-align: left;"><span style="font-size: 10pt;">The data for this study were derived from two multicentre studies. In SPREE we investigated the performance of screening for PE by a combination of maternal characteristics and biomarkers at 11-13 weeks' gestation. In ASPRE women with singleton pregnancies identified by combined screening as being at high risk for preterm-PE (>1 in 100) participated in a trial of aspirin (150 mg/day from 11 to 14 until 36 weeks' gestation), compared to placebo. In this study we used the data from the ASPRE trial to estimate the effect of aspirin on the incidence of SGA with birthweight <10<sup style="line-height: 1.6363em; position: relative; vertical-align: baseline; top: -0.5em;">th</sup> , <5<sup style="line-height: 1.6363em; position: relative; vertical-align: baseline; top: -0.5em;">th</sup> and <3<sup style="line-height: 1.6363em; position: relative; vertical-align: baseline; top: -0.5em;">rd</sup> percentile for gestational age. We also used the data from SPREE to estimate the proportion of SGA in the pregnancies with a risk for preterm-PE of >1 in 100.</span></p><h4 style="font-size: 13px; margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; font-family: arial, helvetica, clean, sans-serif; text-align: left;"><span style="font-size: 10pt;">RESULTS:</span></h4><p style="margin: 0px 0px 0.5em; font-size: 1.04em; font-family: arial, helvetica, clean, sans-serif; text-align: left;"><span style="font-size: 10pt;">In SPREE, screening for preterm-PE by a combination of maternal factors, mean arterial pressure, uterine artery pulsatility index and serum placental growth factor, identified a high-risk group that contained about 46% of SGA <10<sup style="line-height: 1.6363em; position: relative; vertical-align: baseline; top: -0.5em;">th</sup> percentile neonates born at <37 weeks' gestation (preterm) and 56% of those born at <32 weeks (early); the overall screen positive rate was 12.2% (2,014 of 16,451 pregnancies). In the ASPRE trial, use of aspirin reduced the overall incidence of SGA <10<sup style="line-height: 1.6363em; position: relative; vertical-align: baseline; top: -0.5em;">th</sup> percentile by about 40% in babies born at <37 weeks' gestation and by about 73% in babies born at <32 weeks; in babies born at >37 weeks aspirin did not have a significant effect on incidence of SGA. The aspirin-related decrease in incidence of SGA was mainly due to a decrease in the pregnancies with PE, where the decrease was about 70% in babies born at <37 weeks' gestation and about 90% in babies born at <32 weeks. On the basis of these results it was estimated that first trimester screening for preterm-PE and use of aspirin in the high-risk group would potentially reduce the incidence of preterm-SGA and early-SGA by about 20% and 40%, respectively.</span></p><h4 style="font-size: 13px; margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; font-family: arial, helvetica, clean, sans-serif; text-align: left;"><span style="font-size: 10pt;">CONCLUSIONS:</span></h4><p style="margin: 0px 0px 0.5em; font-size: 1.04em; font-family: arial, helvetica, clean, sans-serif; text-align: left;"><span style="font-size: 10pt;">First trimester screening for PE by the combined test identifies a high proportion of cases of preterm-SGA that can be prevented by the prophylactic use of aspirin.</span></p>