The first-trimester of pregnancy: a window of opportunity for prediction and prevention of pregnancy complications and future life

TY - JOUR

T1 - The first-trimester of pregnancy

T2 - a window of opportunity for prediction and prevention of pregnancy complications and future life

AU - Poon, Liona C.

AU - David McIntyre, H.

AU - Hyett, Jonathan A.

AU - Fonseca, Eduardo Borges da

AU - Hod, Moshe

AU - the FIGO Pregnancy and NCD Committee

PY - 2018/5/29

Y1 - 2018/5/29

N2 - The International Federation of Gynecology and Obstetrics (FIGO) has identified non communicable maternal diseases (NCDs) as a new focus area. NCDs and exposures as related to pregnancy complications and later impairment of maternal and offspring health will form the basis for action in the forthcoming years. This paper summarizes recent advances, centered on the use of first-trimester testing, as a window of opportunity to predict and prevent many pregnancy complications; and for potential future prevention of NCDs in mother and offspring. Recent results from a large-scale randomized control trial have provided definitive proof that effective screening for preterm preeclampsia (preterm-PE), requiring delivery before 37 weeks’ gestation, can be achieved with a combined test of maternal factors and biomarkers at 11-13 weeks and that aspirin, given to high-risk women, is effective in reducing the risk of preterm-PE and the length of stay in neonatal intensive care unit. This is the first successful example to illustrate that pregnancy complications is predictable and preventable in early pregnancy. Similar prediction and prevention strategies are being developed for hyperglycemia in pregnancy and preterm birth, with the intention for longer lasting interventions leading to significant downstream impact in improving long-term health in both mothers and babies.

AB - The International Federation of Gynecology and Obstetrics (FIGO) has identified non communicable maternal diseases (NCDs) as a new focus area. NCDs and exposures as related to pregnancy complications and later impairment of maternal and offspring health will form the basis for action in the forthcoming years. This paper summarizes recent advances, centered on the use of first-trimester testing, as a window of opportunity to predict and prevent many pregnancy complications; and for potential future prevention of NCDs in mother and offspring. Recent results from a large-scale randomized control trial have provided definitive proof that effective screening for preterm preeclampsia (preterm-PE), requiring delivery before 37 weeks’ gestation, can be achieved with a combined test of maternal factors and biomarkers at 11-13 weeks and that aspirin, given to high-risk women, is effective in reducing the risk of preterm-PE and the length of stay in neonatal intensive care unit. This is the first successful example to illustrate that pregnancy complications is predictable and preventable in early pregnancy. Similar prediction and prevention strategies are being developed for hyperglycemia in pregnancy and preterm birth, with the intention for longer lasting interventions leading to significant downstream impact in improving long-term health in both mothers and babies.

KW - First-trimester

KW - Prediction

KW - Prevention

KW - Non-communicable diseases

KW - Pregnancy complications

KW - Preeclampsia

KW - Hyperglycemia

KW - Gestational diabetes

KW - Preterm birth

U2 - 10.1016/j.diabres.2018.05.002

DO - 10.1016/j.diabres.2018.05.002

M3 - Article

SN - 0168-8227

JO - Diabetes Research and Clinical Practice

JF - Diabetes Research and Clinical Practice

ER -