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| 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.
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| 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.
