Screening for fetal growth restriction (FGR) by combined screening for preeclampsia (PE) – results from the IPSISS cohort

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Problemstellung First trimester combined screening for fetal growth restriction (FGR) is a two-dimensional screening algorithm based on the same parameters as first trimester combined screening for preeclampsia (PE). The detection rate (DR) of FGR occurring in the context of PE is higher than the DR for FGR alone. Low dose aspirin (LDA) decreases the incidence of preterm FGR (pFGR) also mainly through prevention of preterm PE (pPE); it seems most pFGR that can be prevented by LDA are identified by screening for pPE. The aim of this trial is to test this hypothesis in the IPSISS cohort in comparison to published data. Patienten und Methode We included all singleton pregnancies registered to date in the IPSISS registry which resulted in a live birth after 24 weeks of gestation. The risk for pPE and birth weight (BW) percentiles were calculated on the FMF website, the risk for FGR was provided by the study sites. Comparative analyses were performed on GraphPad Prism 10 for Windows. Ergebnis 1'986 singleton pregnancies with complete screening for pPE were included over the study period, the risk for FGR was assessed in 1’143 (57.6%). 205/1’733 (11.8%) pregnancies with a birth weight (BW) ≥ 10 th percentile and 56/253 (22.1%) with a BW <10 th percentile had a risk >1:100 for pPE (p<0.0001). At the same false-positive rate (FPR) of 11.8% the DR of FGR by combined screening for FGR was 32/130 (24.6%) (p=ns). 221/261 (84.7%) pregnancies at risk for pPE >1:100 were treated with LDA. 21/1’986 (1.1%) were delivered <32 and 118/1’986 (5.9%) <37 weeks of gestation. 6/21 (28.6%) and 23/118 (19.5%) respectively were pFGR. Before 32 weeks 5/6 (83.3%) and befor 37 weeks 10/23 (43.5%) pFGR occurred in the context of pPE. 4/6 (66.7%) and 9/23 (39.1%) each were screen positive for pPE as well as for pFGR. Schlussfolgerung First, our results show that a high percentage of the preterm deliveries are associated with FGR. Second, there is no significant difference in the DR for pFGR in comparison of combined screening for pPE or for pFGR. Third, many pFGR occur in the context of pPE. Since 85% of pregnancies at risk were treated with LDA, we cannot compare the DR in our population with untreated cohorts, however assuming that LDA reduces pFGR <37 weeks by 40%, the incidence of pFGR of 19.5% in our cohort compared to 36% in untreated populations demonstrates the expected LDA-effect. LDA should therefore be prescribed only in the context of a positive screening result for pPE. Publication History Article published online: 04 September 2024 © 2024. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

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