What is the problem?
When pre-eclampsia occurs early in pregnancy, before 34 weeks of gestation, it is more severe than late onset disease and contributes disproportionately to adverse maternal and fetal outcomes. In women with early onset pre-eclampsia, mothers are often delivered early to improve their condition, contributing to prematurity associated complications including death, and long-term neurological disability in the children. This leads to significant costs to the NHS in caring for the preterm baby and societal costs for their long-term care.
What is needed?
Accurate and early identification of women at high risk of pre-eclampsia will allow clinicians to commence preventative interventions such as aspirin, and frequent monitoring in pregnancy.
Where are the gaps in research?
Although over 100 tools (models) have been reported worldwide to predict pre-eclampsia, to-date their performance in women managed in the National Health Service in UK is not known.
What are the aims of the IPPIC network?
To comprehensively identify all published models to predict pre-eclampsia and assess if they accurately predict the risk in UK population by accessing the data of individual women for analysis. If existing models did not perform satisfactorily, IPPIC aims to develop new models to predict early, late and any onset pre-eclampsia.
What did the IPPIC Network find?
The IPPIC (International Prediction of Pregnancy Complications) network provided data from the largest number of studies (78 studies, 25 countries, 125 researchers). Of the 131 models published on prediction of pre-eclampsia, we were able to assess the performance of 24 in 11 UK datasets. The models did not accurately predict the risk of pre-eclampsia across all UK datasets, with varied performance within individual datasets. We developed 12 IPPIC models that showed promising performance on average across all datasets. But their ability to correctly identify women who develop pre-eclampsia varied between populations. The models showed net benefit over and above a strategy of treating all women when applied to first time mothers pregnant with one child in the UK.