title: 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.
authors.affiliation: Department of Obstetrics and Gynaecology, Royal London Hospital, London, UK. lyndaverghese@yahoo.com
authors.forename: L
authors.initials: L
authors.lastname: Verghese
authors.forename: S
authors.initials: S
authors.lastname: Alam
authors.forename: S
authors.initials: S
authors.lastname: Beski
authors.forename: R
authors.initials: R
authors.lastname: Thuraisingham
authors.forename: I
authors.initials: I
authors.lastname: Barnes
authors.forename: P
authors.initials: P
authors.lastname: MacCallum
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011225:Pre-Eclampsia / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011296:Prenatal Diagnosis; D012680:Sensitivity and Specificity