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Elawad T, Scott G, Bone JN, Elwell H, Lopez CE, Filippi V, Green M, Khalil A, Kinshella MLW, Mistry HD, Pickerill K, Shanmugam R, Singer J, Townsend R, Tsigas EZ, Vidler M, Volvert ML, von Dadelszen P, Magee LA. Risk factors for pre-eclampsia in clinical practice guidelines: Comparison with the evidence. BJOG 2024; 131:46-62. [PMID: 36209504 DOI: 10.1111/1471-0528.17320] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 08/12/2022] [Accepted: 09/06/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare pre-eclampsia risk factors identified by clinical practice guidelines (CPGs) with risk factors from hierarchical evidence review, to guide pre-eclampsia prevention. DESIGN Our search strategy provided hierarchical evidence of relationships between risk factors and pre-eclampsia using Medline (Ovid), searched from January 2010 to January 2021. SETTING Published studies and CPGs. POPULATION Pregnant women. METHODS We evaluated the strength of association and quality of evidence (GRADE). CPGs (n = 15) were taken from a previous systematic review. MAIN OUTCOME MEASURE Pre-eclampsia. RESULTS Of 78 pre-eclampsia risk factors, 13 (16.5%) arise only during pregnancy. Strength of association was usually 'probable' (n = 40, 51.3%) and the quality of evidence was low (n = 35, 44.9%). The 'major' and 'moderate' risk factors proposed by 8/15 CPGs were not well aligned with the evidence; of the ten 'major' risk factors (alone warranting aspirin prophylaxis), associations with pre-eclampsia were definite (n = 4), probable (n = 5) or possible (n = 1), based on moderate (n = 4), low (n = 5) or very low (n = 1) quality evidence. Obesity ('moderate' risk factor) was definitely associated with pre-eclampsia (high-quality evidence). The other ten 'moderate' risk factors had probable (n = 8), possible (n = 1) or no (n = 1) association with pre-eclampsia, based on evidence of moderate (n = 1), low (n = 5) or very low (n = 4) quality. Three risk factors not identified by the CPGs had probable associations (high quality): being overweight; 'prehypertension' at booking; and blood pressure of 130-139/80-89 mmHg in early pregnancy. CONCLUSIONS Pre-eclampsia risk factors in CPGs are poorly aligned with evidence, particularly for the strongest risk factor of obesity. There is a lack of distinction between risk factors identifiable in early pregnancy and those arising later. A refresh of the strategies advocated by CPGs is needed.
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Affiliation(s)
- Terteel Elawad
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Georgia Scott
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- North West London Foundation School, London, UK
| | - Jeffrey N Bone
- Department of Obstetrics and Gynaecology, University of British Columbia, British Columbia, Vancouver, Canada
- BC Children's Hospital Research Institute, University of British Columbia, British Columbia, Vancouver, Canada
| | - Helen Elwell
- British Medical Association (BMA) Library, BMA, London, UK
| | - Cristina Escalona Lopez
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | | | | | - Asma Khalil
- St George's Hospital NHS Foundation Trust, London, UK
| | - Mai-Lei W Kinshella
- Department of Obstetrics and Gynaecology, University of British Columbia, British Columbia, Vancouver, Canada
- BC Children's Hospital Research Institute, University of British Columbia, British Columbia, Vancouver, Canada
| | - Hiten D Mistry
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Kelly Pickerill
- Department of Obstetrics and Gynaecology, University of British Columbia, British Columbia, Vancouver, Canada
- BC Children's Hospital Research Institute, University of British Columbia, British Columbia, Vancouver, Canada
| | - Reshma Shanmugam
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- West Midlands Central Foundation School, Birmingham, UK
| | - Joel Singer
- School of Population and Public Health, University of British Columbia, British Columbia, Vancouver, Canada
- Centre for Health Evaluation and Outcome Sciences, University of British Columbia, British Columbia, Vancouver, Canada
| | | | | | - Marianne Vidler
- Department of Obstetrics and Gynaecology, University of British Columbia, British Columbia, Vancouver, Canada
- BC Children's Hospital Research Institute, University of British Columbia, British Columbia, Vancouver, Canada
| | - Marie-Laure Volvert
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Peter von Dadelszen
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department of Obstetrics and Gynaecology, University of British Columbia, British Columbia, Vancouver, Canada
- BC Children's Hospital Research Institute, University of British Columbia, British Columbia, Vancouver, Canada
| | - Laura A Magee
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department of Obstetrics and Gynaecology, University of British Columbia, British Columbia, Vancouver, Canada
- BC Children's Hospital Research Institute, University of British Columbia, British Columbia, Vancouver, Canada
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