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Pre-EclampsiaFORECASTNCT03941886

Implementation of First-trimester Screening and preventiOn of pREeClAmpSia Trial (FORECAST)

A study testing Low-dose aspirin in women with high risk of preeclampsia in people with Pre-Eclampsia, run by Chiu Yee Liona Poon at 19 sites in 10 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This implementation study aims to evaluate the efficacy, acceptability, and safety of first-trimester screening and prevention for preterm-preeclampsia. It is a multicenter stepped wedge cluster randomized trial including maternity / diagnostic units from ten regions in Asia. Read more about this study

Who is it for?
Ages 18 years and older, women only
Conditions the study is for
Pre-Eclampsia
What is being tested?
Low-dose aspirin in women with high risk of preeclampsia
Could I receive a placebo?
No, everyone receives an active treatment
How many people
42,454 participants
Where
19 sitesin 10 countries
Study dates
31 Jul 2019to 15 Aug 2023
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • Women only
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Singleton pregnancy;
  • Live fetus;

Who cannot join

  • Multiple pregnancy;
  • Major fetal defects identified at 11-13 weeks of assessment;
  • Non-viable fetus (missed spontaneous abortion or stillbirth).

Trial locations and contacts

19 sites in 10 countries.

19 sites in 10 countries

Thailand4 sites
  • Chulalongkorn University Hospital

    Bangkok

  • Siriraj Hospital

    Bangkok

  • Maharaj Nakorn Chiang Mai Hospital

    Chiang Mai

  • Thammasat University Hospital

    Khlong Luang

Other trials in Thailand

China3 sites
  • Guangzhou Women and Children's Medical Center

    Guangzhou

  • Kunming Angel Women & Children Hospital

    Kunming

  • Nanjing Drum Tower Hospital

    Nanjing

Other trials in China

Japan3 sites
  • Clinical Research Institute of Fetal Medicine

    Osaka

  • Showa University Hospital

    Tokyo

  • Japan Society for the Study of Hypertension in Pregnancy

    Toyama

Other trials in Japan

Hong Kong2 sites
  • Prince of Wales Hospital

    Hong Kong, Hong Kong, China, Shatin

  • Kwong Wah Hospital

    Hong Kong

Other trials in Hong Kong

Taiwan2 sites
  • Chang Gung Hospital

    Taipei

  • Taiji Clinic

    Taipei

Other trials in Taiwan

Indonesia1 site
  • Harapan Kita Hospital

    Jakarta

Other trials in Indonesia

Malaysia1 site
  • Pusat Perubatan Universiti Kebangsaan Malaysia (UKM) Medical Centre

    Bandar Tun Razak

Other trials in Malaysia

Philippines1 site
  • Philippine General Hospital

    Manila

Other trials in Philippines

Singapore1 site
  • National University Hospital

    Singapore

Other trials in Singapore

Vietnam1 site
  • Hanoi Obstetrics & Gynecology Hospital

    Hanoi

Other trials in Vietnam

About this study

Official title: Implementation of First-trimester Screening and Prevention of Preeclampsia: a Stepped Wedge Cluster-randomized Trial in Asia

This implementation study aims to evaluate the efficacy, acceptability, and safety of first-trimester screening and prevention for preterm-preeclampsia. It is a multicenter stepped wedge cluster randomized trial including maternity / diagnostic units from ten regions in Asia. The study involves a period where no intervention will take place at all recruiting units, and then at regular intervals, one cluster will be randomized to transit from non-intervention group to intervention group in which first-trimester screening for preterm-preeclampsia by the Bayes based method followed by the commencement of low-dose aspirin in high-risk women.

Conditions
Pre-Eclampsia
Being tested
Low-dose aspirin in women with high risk of preeclampsia
Keywords
Pre-Eclampsia, Aspirin
Medical subject headings
Pre-Eclampsia

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Low-dose aspirin in women with high risk of preeclampsiaOther

    Low-dose aspirin 150-162 mg/night or 100 mg/night if body weight <40 Kg, from <15 weeks till 36 weeks or, in the event of early delivery, at the onset of labor

Study groups in NCT03941886
Study groupRoleWhat they receive
Non-intervention groupNo interventionParticipants receive routine prenatal care
Intervention groupExperimentalParticipants receive first-trimester screening for preterm-preeclampsia by the Bayes based method followed by commencement of low-dose aspirin prophylaxis in high-risk women.
Receives: Other: Low-dose aspirin in women with high risk of preeclampsia

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Delivery with preterm-preeclampsia

    Proportions of delivery with preterm preeclampsia between non-intervention and intervention groups

    Measured: Before 37 weeks of gestation

Secondary outcomes (10)
  1. Adverse outcomes with delivery at <34, <37 and ≥37 weeks of gestation

    including preeclampsia, gestational hypertension, small for gestational age birth weight (<5th percentile), stillbirth, placental abruption

    Measured: at <34, <37 and ≥37 weeks of gestation

  2. Neonatal mortality

    A neonatal death is a death during 0-27 days of life. Composite neonatal morbidity (any one of the following): > grade II intraventricular hemorrhage; neonatal sepsis confirmed by cultures; neonatal anemia requiring transfusion; respiratory distress syndrome requiring surfactant and ventilation; necrotising enterocolitis requiring surgical intervention.

    Composite neonatal therapy (any one of the following): Neonatal high dependency or intensive care unit admission; Ventilation - need of positive pressure or intubation.

    Measured: during the first 28 days of life (0-27 days)

  3. Low birth weight

    Low birth weight <3rd, 5th and 10th percentile

    Measured: at birth

  4. Stillbirth

    Fetal death at or after 20 to 28 weeks of pregnancy

    Measured: at or after 20 to 28 weeks of pregnancy

  5. Spontaneous preterm birth

    Spontaneous preterm birth (SPB) includes preterm labor, preterm spontaneous rupture of membranes, preterm premature rupture of membranes (PPROM) and cervical weakness; it does not include indicated preterm delivery for maternal or fetal conditions.

    Measured: At <34 and <37 weeks' gestation

  6. Acceptability for PE screening

    If subjects are under the intervention group upon proper consent procedure is done, at 11-13 weeks of gestation, the procedures below will be done.

    1. Collection of maternal information (obstetrical, medical and drug history including aspirin intake with indication)
    2. Measurement of maternal MAP and UtA-PI will be measured according to standardized protocols.
    3. Blood sample will be drawn to determine of serum level of PIGF.

    The individual study participant's risk of preterm-PE will be computed using the Bayes based method.

    Measured: in the first trimester of pregnancy (11-13 weeks of gestation)

  7. Acceptability for aspirin treatment.

    When patients are subjected to be high risks in preeclampsia screening, they will be asked if they accept the aspirin for treatment. If they do not accept, they will continue with routine care. The willingness of subjects will all be recorded on the Case report forms for data collection.

    Measured: from <15 weeks till 36 weeks of gestation or, in the event of early delivery, at the onset of labor

  8. Composite neonatal morbidity

    Composite neonatal morbidity (any one of the following): > grade II intraventricular hemorrhage; neonatal sepsis confirmed by cultures; neonatal anemia requiring transfusion; respiratory distress syndrome requiring surfactant and ventilation; necrotising enterocolitis requiring surgical intervention.

    Measured: during the first 28 days of life (0-27 days)

  9. Composite neonatal therapy

    Composite neonatal therapy (any one of the following): Neonatal high dependency or intensive care unit admission; Ventilation - need of positive pressure or intubation.

    Measured: during the first 28 days of life (0-27 days)

  10. Gestational age at delivery

    Gestational age at delivery

    Measured: at delivery

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted8 May 2019
  2. Study start31 Jul 2019
  3. Primary completion15 Jun 2023
  4. Study completion15 Aug 2023

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Sequential
Model description
This is a stepped wedge cluster-randomized trial. There are total of 7 clusters across Asia. This study involves a period where no intervention will take place at all recruiting units, i.e. routine prenatal care, and then at regular intervals (every 6 weekly), one cluster will be randomized to transit from non-intervention group to intervention group in which first-trimester screening for preterm-preeclampsia by the Bayes based method followed by commencement of low-dose aspirin prophylaxis for high-risk women.
Masking
None (open label)
Enrolment
42,454 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03941886
Sponsor's protocol ID
2018-0434
Acronym
FORECAST
Status last verified
Nov 2023
First submitted
19 Dec 2018
Last updated
29 Nov 2023
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Geographic variation in the incidence of hypertension in pregnancy. World Health Organization International Collaborative Study of Hypertensive Disorders of Pregnancy. Am J Obstet Gynecol. 1988 Jan;158(1):80-3.

    PubMed 2962500
  • Steegers EA, von Dadelszen P, Duvekot JJ, Pijnenborg R. Pre-eclampsia. Lancet. 2010 Aug 21;376(9741):631-44. doi: 10.1016/S0140-6736(10)60279-6. Epub 2010 Jul 2.

    PubMed 20598363
  • Khan KS, Wojdyla D, Say L, Gulmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006 Apr 1;367(9516):1066-1074. doi: 10.1016/S0140-6736(06)68397-9.

    PubMed 16581405
  • Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists' Task Force on Hypertension in Pregnancy. Obstet Gynecol. 2013 Nov;122(5):1122-1131. doi: 10.1097/01.AOG.0000437382.03963.88. No abstract available.

    PubMed 24150027
  • Tranquilli AL, Dekker G, Magee L, Roberts J, Sibai BM, Steyn W, Zeeman GG, Brown MA. The classification, diagnosis and management of the hypertensive disorders of pregnancy: A revised statement from the ISSHP. Pregnancy Hypertens. 2014 Apr;4(2):97-104. doi: 10.1016/j.preghy.2014.02.001. Epub 2014 Feb 15. No abstract available.

    PubMed 26104417
  • National Collaborating Centre for Women's and Children's Health (UK). Hypertension in Pregnancy: The Management of Hypertensive Disorders During Pregnancy. London: RCOG Press; 2010 Aug. Available from http://www.ncbi.nlm.nih.gov/books/NBK62652/

    PubMed 22220321
  • Committee Opinion No. 638: First-Trimester Risk Assessment for Early-Onset Preeclampsia. Obstet Gynecol. 2015 Sep;126(3):e25-e27. doi: 10.1097/AOG.0000000000001049.

    PubMed 26287789
  • Wright D, Syngelaki A, Akolekar R, Poon LC, Nicolaides KH. Competing risks model in screening for preeclampsia by maternal characteristics and medical history. Am J Obstet Gynecol. 2015 Jul;213(1):62.e1-62.e10. doi: 10.1016/j.ajog.2015.02.018. Epub 2015 Feb 25.

    PubMed 25724400
  • O'Gorman N, Wright D, Syngelaki A, Akolekar R, Wright A, Poon LC, Nicolaides KH. Competing risks model in screening for preeclampsia by maternal factors and biomarkers at 11-13 weeks gestation. Am J Obstet Gynecol. 2016 Jan;214(1):103.e1-103.e12. doi: 10.1016/j.ajog.2015.08.034. Epub 2015 Aug 19.

    PubMed 26297382
  • O'Gorman N, Wright D, Poon LC, Rolnik DL, Syngelaki A, de Alvarado M, Carbone IF, Dutemeyer V, Fiolna M, Frick A, Karagiotis N, Mastrodima S, de Paco Matallana C, Papaioannou G, Pazos A, Plasencia W, Nicolaides KH. Multicenter screening for pre-eclampsia by maternal factors and biomarkers at 11-13 weeks' gestation: comparison with NICE guidelines and ACOG recommendations. Ultrasound Obstet Gynecol. 2017 Jun;49(6):756-760. doi: 10.1002/uog.17455.

    PubMed 28295782
  • Rolnik DL, Wright D, Poon LC, O'Gorman N, Syngelaki A, de Paco Matallana C, Akolekar R, Cicero S, Janga D, Singh M, Molina FS, Persico N, Jani JC, Plasencia W, Papaioannou G, Tenenbaum-Gavish K, Meiri H, Gizurarson S, Maclagan K, Nicolaides KH. Aspirin versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia. N Engl J Med. 2017 Aug 17;377(7):613-622. doi: 10.1056/NEJMoa1704559. Epub 2017 Jun 28.

    PubMed 28657417
  • Plasencia W, Maiz N, Poon L, Yu C, Nicolaides KH. Uterine artery Doppler at 11 + 0 to 13 + 6 weeks and 21 + 0 to 24 + 6 weeks in the prediction of pre-eclampsia. Ultrasound Obstet Gynecol. 2008 Aug;32(2):138-46. doi: 10.1002/uog.5402.

    PubMed 18634131
  • Poon LC, Zymeri NA, Zamprakou A, Syngelaki A, Nicolaides KH. Protocol for measurement of mean arterial pressure at 11-13 weeks' gestation. Fetal Diagn Ther. 2012;31(1):42-8. doi: 10.1159/000335366. Epub 2012 Jan 13.

    PubMed 22248988
  • Chen Y, Nguyen-Hoang L, Dinh LT, Nguyen DA, Pooh RK, Shiozaki A, Zheng M, Hu Y, Ma R, Kusuma A, Wataganara T, Choolani MA, Kaneko M, Luewan S, Chang TY, Chaiyasit N, Nanthakomon T, Jiang Y, Shaw SW, Leung WC, Mohamad AS, Aguilar A, Lau SL, Lee NMW, Liu J, Sahota DS, Chong MKC, Papastefanou I, Poon LC. Effect of aspirin on small for gestational age neonates in pregnancies at high-risk for preeclampsia: a secondary analysis of a cluster randomised clinical trial. Lancet Reg Health West Pac. 2025 Jun 5;59:101582. doi: 10.1016/j.lanwpc.2025.101582. eCollection 2025 Jun.

    PubMed 40529816
  • Nguyen-Hoang L, Dinh LT, Tai AST, Nguyen DA, Pooh RK, Shiozaki A, Zheng M, Hu Y, Li B, Kusuma A, Yapan P, Gosavi A, Kaneko M, Luewan S, Chang TY, Chaiyasit N, Nanthakomon T, Liu H, Shaw SW, Leung WC, Mahdy ZA, Aguilar A, Leung HHY, Lee NMW, Lau SL, Wah IYM, Lu X, Sahota DS, Chong MKC, Poon LC; FORECAST Collaborators. Implementation of First-Trimester Screening and Prevention of Preeclampsia: A Stepped Wedge Cluster-Randomized Trial in Asia. Circulation. 2024 Oct 15;150(16):1223-1235. doi: 10.1161/CIRCULATIONAHA.124.069907. Epub 2024 Jun 26.

    PubMed 38923439

Questions about this trial

What is this clinical trial studying?

A study testing Low-dose aspirin in women with high risk of preeclampsia in people with Pre-Eclampsia, run by Chiu Yee Liona Poon at 19 sites in 10 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 2 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 29 Nov 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 19 sites in Thailand, China, Japan, Hong Kong, Taiwan and 5 more countries. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Delivery with preterm-preeclampsia (time frame: Before 37 weeks of gestation). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03941886, which also lists 15 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 29 Nov 2023.

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