Antenatal screening for pre-eclampsia: Evaluation of the NICE and pre-eclampsia community guidelines

Abstract

The NICE and PRECOG guidelines are based on systematic reviews of risk factors for pre-eclampsia to identify mothers at risk before 20 weeks’ gestation. Cases (64) and controls (112) were classified retrospectively as screen positive or negative as recommended by the two guidelines The NICE guideline had a higher sensitivity rate of 77% (95% CI 65–87%) vs 59% (95% CI 46–71%) but a lower specificity of 54% (95% CI 44–64%) vs 81% (95% CI 73–88%) with the PRECOG guideline. Based on an incidence of pre-eclampsia of 4% the positive predictive values of PRECOG and NICE guidelines were estimated at only 11% and 7%, respectively. The most discriminatory risk factor was history of pre-eclampsia in a previous pregnancy. Neither guideline has a reasonable performance and cannot be recommended for use in clinical practice. Resources should rather be focussed on development of new strategies to identify women at risk of pre-eclampsia.

Keywords::

• Antenatal screening
• NICE guidelines
• PRECOG guidelines
• pre-eclampsia
• risk factors

Declaration of interest:

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.