Clinical risk factors for pre-eclampsia determined in early pregnancy



i'm dr. joel ray in toronto canada on behalf of emily Barch and the high risk of preeclampsia identification group discussing our BMJ article on clinical risk factors for preeclampsia i have no conflict of interest nor do our co-authors we know that aspirin has the capacity to prevent preeclampsia in women deemed to be at higher risk of getting preeclampsia this aspirin prophylaxis has been validated through many randomized clinical trials in pregnancy and several international organizations who have published guidelines endorsed the use of aspirin one of the issues has been the inability to identify which women are truly at high risk of preeclampsia and who warned aspirin so what we did in our current paper was a systematic review and meta-analysis of large cohort studies in women who either did or didn't have a given risk factor for preeclampsia and those risk factors would be available to clinicians such as midwives obstetricians family physicians and nurse practitioners when they were filling out a prenatal care form or otherwise an antenatal care form that's used in pregnancy care we only included studies with at least 1,000 women and only cohort studies and we wanted risk factors that could be identified early enough in pregnancy to efficaciously initiate aspirin and on this slide what you'll see is essentially a combination or pooling of all the data for a given risk factor the first is a prior intrauterine growth restriction SLE for lupus and the list goes on in the light blue are women without that given risk factor in the darker blue or women with that risk factor and on the x-axis is the probability of the woman getting preeclampsia with that risk factor along with an upper and lower 95% confidence interval we also present a relative risk comparing women with and without that risk factor pooled across the cohort studies and as the list is complete you can see different risk factors contributing different probabilities of preeclampsia we then using a number needed to prevent threshold of 250 or less as an objective point at which aspirin would be warranted or should be started in a woman at high enough risk for preeclampsia and using a 10% relative risk reduction 30 percent relative risk reduction or up to 50% relative risk reduction efficacy for aspirin prophylaxis we were able to judge each risk factor as being above or below that threshold number needed to prevent which is 250 and to the left of it on that figure and what we arrived at based on that list of risk factors that we felt clinicians could use was the following figure which isn't included in the BMJ paper but is presented here in this video in the green circle our risk factors that if one alone is present would warrant aspirin prophylaxis in a woman because she is high enough risk likely to warrant aspirin now others would argue that this circle isn't validated enough and is really more a guide for future research and that debate can continue based on this video in this paper in a red circle are women in whom we think they require at least two of these risk factors or more to warrant aspirin prophylaxis and again clinicians and researchers can continue the debate about that red circle and green circle the red circles and green circles ultimately will cross each other women may have some risk factors in the green circle and some in the risk factors present in the red circle and again will allow that discussion to continue but we're grateful to the BMJ and glad to talk with you today thank you

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