Paula Busuulwa, Kate Duhig, Paul T Seed, Andrew H Shennan, Lucy C Chappell
Department of Women and Children’s Health, King’s College London, United Kingdom
Introduction (include hypothesis)
Pre-eclampsia (PE) is an important cause of indicated preterm birth. Antenatal corticosteroids (ACS) should be offered to all women who are likely to deliver within 7 days, between 24 and 34+6 weeks’ gestation. Placental growth factor (PlGF) has good test performance in determining need for delivery in women with suspected preterm pre-eclampsia. We determined current practice of steroid administration in women delivering with preterm pre-eclampsia and assessed the value of PLGF in targeting their use.
Methods (include source of funding and ethical approval if required)
We analysed women presenting with suspected pre-eclampsia in the PELICAN study and PARROT trials, two large multicentre UK trials that evaluated the diagnostic accuracy of PLGF as a marker of preeclampsia (PELICAN) and impact of revealed testing when implemented as part of routine care (PARROT). We determined what proportion received ACS, including within 7 days of delivery. We evaluated how use of revealed PlGF testing may impact on ACS administration in suspected pre-eclampsia. REC 10/H0701/117 (PELICAN) and 15/LO/2058 (PARROT). Funder: Tommy’s Charity and NIHR RfPB.
In PELICAN and PARROT (concealed testing groups), 173 women delivered before 35 weeks’ gestation. Overall, only 26% women delivering prior to 35 weeks’ gestation received ACS within 7 days of delivery and 27% received no ACS at all. If ACS use was targeted at women with suspected PE and low PLGF <100pg/mL, 50% of women would have received ACS within 7 days of delivery. At a threshold of 100pg/ml, PlGF had a high negative predictive value (99%) for delivery within 7 days.
In the PARROT trial (concealed vs. revealed testing), appropriate ACS use increased with revealed PlGF testing. Of those delivering prior to 35 weeks’ gestation, steroid administration within 7 days of delivery increased from 16% (6/38) to 39% (29/75) in women with PlGF <12 pg/ml, and from 26% (5/19) to 38% (12/32) in women with PlGF 12-100pg/ml.
In current practice, only a minority of women delivering before 35 weeks receive optimal ACS administration. Use of PIGF testing may assist in increasing appropriate use of ACS in women with suspected preeclampsia, through better stratification of risk and identification of need for delivery within 7 days.
References (include acknowledgement here if appropriate)
Chappell et al. Circulation. 2013 Nov 5;128(19):2121-31. doi: 10.1161/CIRCULATIONAHA.113.003215.
Duhig et al. Lancet. 2019 May 4;393(10183):1807-1818. doi: 10.1016/S0140-6736(18)33212-4.