Risk factors for pre-eclampsia in clinical practice guidelines: Comparison with the evidence

Terteel Elawad; Georgia Scott; Jeffrey N. Bone; Helen Elwell; Cristina Escalona Lopez; Veronique Filippi; Marcus Green; Asma Khalil; Mai Lei W. Kinshella; Hiten D. Mistry; Kelly Pickerill; Reshma Shanmugam; Joel Singer; Rosemarie Townsend; Eleni Z. Tsigas; Marianne Vidler; Marie Laure Volvert; Peter von Dadelszen; Laura A. Magee

doi:10.1111/1471-0528.17320

Risk factors for pre-eclampsia in clinical practice guidelines: Comparison with the evidence

Terteel Elawad, Georgia Scott, Jeffrey N. Bone, Helen Elwell, Cristina Escalona Lopez, Veronique Filippi, Marcus Green, Asma Khalil, Mai Lei W. Kinshella, Hiten D. Mistry, Kelly Pickerill, Reshma Shanmugam, Joel Singer, Rosemarie Townsend, Eleni Z. Tsigas, Marianne Vidler, Marie Laure Volvert, Peter von Dadelszen, Laura A. Magee^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

22 Citations (Scopus)

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.

Original language	English
Pages (from-to)	46-62
Number of pages	17
Journal	BJOG: An International Journal of Obstetrics and Gynaecology
Volume	131
Issue number	1
DOIs	https://doi.org/10.1111/1471-0528.17320
Publication status	Published - Jan 2024

Keywords

determinants
outcomes
pre-eclampsia
prevention
risk factors

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1111/1471-0528.17320

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Elawad, T., Scott, G., Bone, J. N., Elwell, H., Lopez, C. E., Filippi, V., Green, M., Khalil, A., Kinshella, M. L. W., Mistry, H. D., Pickerill, K., Shanmugam, R., Singer, J., Townsend, R., Tsigas, E. Z., Vidler, M., Volvert, M. L., von Dadelszen, P., & Magee, L. A. (2024). Risk factors for pre-eclampsia in clinical practice guidelines: Comparison with the evidence. BJOG: An International Journal of Obstetrics and Gynaecology, 131(1), 46-62. https://doi.org/10.1111/1471-0528.17320

@article{a139b8606c2d406a8f7614fd328cae17,

title = "Risk factors for pre-eclampsia in clinical practice guidelines: Comparison with the evidence",

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 {\textquoteleft}probable{\textquoteright} (n = 40, 51.3%) and the quality of evidence was low (n = 35, 44.9%). The {\textquoteleft}major{\textquoteright} and {\textquoteleft}moderate{\textquoteright} risk factors proposed by 8/15 CPGs were not well aligned with the evidence; of the ten {\textquoteleft}major{\textquoteright} 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 ({\textquoteleft}moderate{\textquoteright} risk factor) was definitely associated with pre-eclampsia (high-quality evidence). The other ten {\textquoteleft}moderate{\textquoteright} 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; {\textquoteleft}prehypertension{\textquoteright} 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.",

keywords = "determinants, outcomes, pre-eclampsia, prevention, risk factors",

author = "Terteel Elawad and Georgia Scott and Bone, {Jeffrey N.} and Helen Elwell and Lopez, {Cristina Escalona} and Veronique Filippi and Marcus Green and Asma Khalil and Kinshella, {Mai Lei W.} and Mistry, {Hiten D.} and Kelly Pickerill and Reshma Shanmugam and Joel Singer and Rosemarie Townsend and Tsigas, {Eleni Z.} and Marianne Vidler and Volvert, {Marie Laure} and {von Dadelszen}, Peter and Magee, {Laura A.}",

note = "Funding Information: This work was supported by funding from a UK Research and Innovation Global Challenges Research Fund (GCRF) GROW award (MR/P027938/1). Publisher Copyright: {\textcopyright} 2022 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.",

year = "2024",

month = jan,

doi = "10.1111/1471-0528.17320",

language = "English",

volume = "131",

pages = "46--62",

journal = "BJOG: An International Journal of Obstetrics and Gynaecology",

issn = "1470-0328",

publisher = "Blackwell Publishing Ltd",

number = "1",

}

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 2024, 'Risk factors for pre-eclampsia in clinical practice guidelines: Comparison with the evidence', BJOG: An International Journal of Obstetrics and Gynaecology, vol. 131, no. 1, pp. 46-62. https://doi.org/10.1111/1471-0528.17320

TY - JOUR

T1 - Risk factors for pre-eclampsia in clinical practice guidelines

T2 - Comparison with the evidence

AU - Elawad, Terteel

AU - Scott, Georgia

AU - Bone, Jeffrey N.

AU - Elwell, Helen

AU - Lopez, Cristina Escalona

AU - Filippi, Veronique

AU - Green, Marcus

AU - Khalil, Asma

AU - Kinshella, Mai Lei W.

AU - Mistry, Hiten D.

AU - Pickerill, Kelly

AU - Shanmugam, Reshma

AU - Singer, Joel

AU - Townsend, Rosemarie

AU - Tsigas, Eleni Z.

AU - Vidler, Marianne

AU - Volvert, Marie Laure

AU - von Dadelszen, Peter

AU - Magee, Laura A.

N1 - Funding Information: This work was supported by funding from a UK Research and Innovation Global Challenges Research Fund (GCRF) GROW award (MR/P027938/1). Publisher Copyright: © 2022 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.

PY - 2024/1

Y1 - 2024/1

N2 - 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.

AB - 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.

KW - determinants

KW - outcomes

KW - pre-eclampsia

KW - prevention

KW - risk factors

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DO - 10.1111/1471-0528.17320

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JO - BJOG: An International Journal of Obstetrics and Gynaecology

JF - BJOG: An International Journal of Obstetrics and Gynaecology

IS - 1

ER -

Risk factors for pre-eclampsia in clinical practice guidelines: Comparison with the evidence

Abstract

Keywords

UN SDGs

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