Monday, 17 July 2017

Monash researchers’ landmark research into pre-eclampsia highlighted at world congress in fetal medicine

Dr Rolnik presenting at the FMF World Congress
Monash University’s Associate Professor Fabricio Costa and Monash Health maternal-fetal medicine fellow Dr Daniel Rolnik presented ground-breaking research into pre-eclampsia at the Fetal Medicine Foundation’s World Congress in Slovenia last month.

Attended by over 2000 delegates from around the world, Dr Rolnik and Associate Professor Costa, a consultant sonologist at Monash Health, presented their research findings about screening for and predicting pre-eclampsia.

Dr Rolnik, first author of a landmark study published in the New England Journal of Medicine, found that administering low-dose aspirin (150mg) led to a 62 per cent reduction in the rate of pre-term pre-eclampsia, resulting in delivery before 37 weeks.

“Our study found an 82 per cent reduction in the rate of early pre-eclampsia, resulting in delivery before 34 weeks,” Dr Rolnik said.

“The ASPRE study was a European trial involving 13 hospitals in which we screened almost 27,000 women for pre-eclampsia at 11-13 weeks by a combination of detailed maternal history, blood pressure and ultrasound measurements, and blood test. We have shown that it is possible to accurately screen pregnant women for preeclampsia at the time of the first trimester ultrasound, and that aspirin is highly effective in preventing early and severe forms of the disease.”

The double blind, placebo-controlled trial of 1,776 women at high risk for pre-term pre-eclampsia found a lower incidence of developing the disease in women taking aspirin than those taking a placebo. Pre-term pre-eclampsia occurred in 13 participants (1.6%) in the aspirin group, compared to 35 (4.3%) in the placebo group.

The pregnant women were given a dose of 150mg per day from between 11 to 14 weeks of pregnancy, after deemed to be high risk for PE using a multiparametric screening involving maternal history, mean arterial blood pressure, uterine artery Doppler and checking two blood biomarkers called PAPP-A and PlGF, up until 36 weeks.

Dr Rolnik said the results prompted calls for low-dose aspirin to be routinely prescribed to women at risk of the disease.

The ASPRE study was designed and led by Professor Kypros Nicolaides, a world renowned Fetal Medicine specialist, and conducted with the support of the Fetal Medicine Foundation (London, UK).
Also at the conference, considered to be the major world congress in fetal medicine, Associate Professor Costa gave two presentations about his research using novel biomarkers to predict preterm and term pre-eclampsia and the accuracy of second trimester prediction of preterm pre-eclampsia by three different screening methods.
Associate Professor Fabricio Costa

“In partnership with Dr Guiying Nie from Hudson Institute, we found that a cardiac biomarker, GDF15, was significantly reduced in the third trimester in women presenting with pre-eclampsia, especially in late-onset cases, and that HtrA3 has potential utility for first trimester prediction of pre-eclampsia,” Associate Professor Costa said.

In another study, Associate Professor Costa compared the performance of three difference screening methods (NICE guidelines, ACOG recommendations and FMF algorithm) for second trimester prediction of pre-eclampsia.

Associate Professor Costa said his research showed that second trimester combined screening for preterm preeclampsia by maternal history, mean arterial pressure and mean uterine artery Doppler pulsatility index (FMF algorithm) was superior than screening by maternal factors alone (NICE guidelines and ACOG recommendations).

As well as his NEJM paper, Dr Rolnik presented his research findings on the reliability of sonographers in measuring ultrasound parameters (uterine artery Doppler) to screen for pre-eclampsia.

“Having analysed more than 25,000 pregnancies in Australia, we found that about 90 per cent of operators measured accurately when well trained,” Dr Rolnik said.

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