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Pre-EclampsiaCRISPNCT04767438

Preeclampsia Sequential Screening Using Angiogenic Factors During First Trimester of Pregnancy

An observational study of Pre-Eclampsia and Pregnancy Complications, run by Instituto de Investigación Sanitaria Aragón.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

Preeclampsia (PE) affects from 2 to 8% of pregnant women. Recent studies show that prevention is the best strategy to improve perinatal outcomes. Therefore, the development of new strategies for preeclampsia screening becomes essential in order to determine the individual risk for each patient, and thus, to identify… Read more about this study

Who is it for?
Ages 18 years and older, women only
Conditions the study is for
Pre-Eclampsia, Pregnancy Complications
What is being tested?
Pregnant women
How many people
6,560 participants
Where
No sites listed yet
Study dates
Mar 2021to Sep 2022
Phase
Observational
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

Study population: Every singleton pregnancy attending during the period study

Who may be able to join

  • Singleton pregnancies;
  • Gestational age less than 14 weeks, estimated according to Crown-Rump Length (CRL);
  • Blood sample between 8 and 14 weeks of pregnancy;
  • Patients who accept to participate in the study and sign the informed consent

Who cannot join

  • Fetus with chromosomal disorders, major congenital malformations or congenital infections diagnosed in the first-trimester ultrasound;
  • Multiple pregnancies;
  • Non-acceptance of participation in the study.

Trial locations and contacts

No sites are listed yet.

Daniel Oros, PhD contact

0034616612323

danoros@unizar.es

About this study

Official title: STUDY PROTOCOL FOR A PROSPECTIVE, MULTICENTRE, COHORT STUDY: Preeclampsia Sequential Screening Using Angiogenic Factors During First Trimester of Pregnancy (CRISP STUDY)

Preeclampsia (PE) affects from 2 to 8% of pregnant women. Recent studies show that prevention is the best strategy to improve perinatal outcomes. Therefore, the development of new strategies for preeclampsia screening becomes essential in order to determine the individual risk for each patient, and thus, to identify those who would be candidates for receiving prophylactic treatment with low-dose aspirin from the first trimester of pregnancy. The aim of our study is to determine prospectively, during clinical practice, the predictive and preventive capacity of a model of preeclampsia sequential screening in the first trimester of pregnancy.

This is a prospective, multicentre, cohort study, with the collaboration of Hospital de la Santa Creu i Sant Pau (Barcelona), Hospital Universitario de Cruces (Bilbao), Hospital Son Llàtzer (Mallorca) and Hospital Clínico Universitario Lozano Blesa (Zaragoza). Women with a singleton pregnancy attending to the 12-week ultrasound scan at one of the maternity hospitals participating in the study between March 1st 2021 and 30th October 2021 will be recruited. Patients who accept to participate in the study will be classified into three risk groups (low-risk, moderate-risk and high risk) based on medical history, Mean Arterial Pressure (MAP), Pregnancy-Associated Plasma Protein A (PAPP-A) and Uterine Artery Pulsatility Index (UTPI). Placental Growth Factor (PlGF) will only be determined in those patients classified as intermediate risk after this first step and then reclassified in high and low-risk patients depending on its values. The number of first-trimester scans performed by these hospitals is approximately 8200 patients annually. Due to PE prevalence in our environment is around 3% of the total population, a total of 246 cases of PE are to be expected. Therefore, based on similar previous experiences, we could assume that 80% of the patients will accept to participate in the study, meaning a total sample of 6560 pregnant women.

Read the detailed description

All the data required to carry out this study, including those derived from sonographies and blood tests, will be collected during the normal pregnancy control, without further appointments. A blood test will be requested in all pregnant women in the first appointment of pregnancy control between 9 and 13 weeks, to determine risk of chromosomal disorders according to the national protocol and it will be used this same sample to analyze angiogenic factors without requiring new blood extractions. In the first-trimester scan, the mean uterine arteries pulsatility index will be determined, as well as mean arterial pressure. In this visit, the patient will be asked about her medical history. We will offer the patients the inclusion to our study in that moment; those who agree to participate in the study will sign the informed consent. In the participants, the initial risk of PE will be calculated using maternal medical history, MAP, UTPI and PAPP-A (already used in aneuploidies screening), using the software validated to each laboratory. Patients will be classified into 3 groups:

  • Low risk of PE (<1/500)
  • Intermediate risk of PE (between 1/50 and 1/500)
  • High risk of PE (>1/50) In those patients classified as intermediate and high-risk, PlGF and s-Flt-1 will be determined from the blood samples kept in biobanks of each hospital according to the current legislation. SFlt-1 results will be analyzed at the end of the study in order to decrease the cost because there will not be used to make clinical decisions. PlGF in high-risk patients will not be considered either to reclassify those patients. In both cases, the diagnostic efficiency will be analyzed at the end of the study.

Patients in the intermediate-risk group (1/50-1/500) will be reclassified after adding PlGF levels in the predictive algorithm in 2 groups: Low risk of PE (<1/160) and High risk of PE (>1/160).

To the patients classified as high risk at any of the steps, will be offered prophylactic treatment with AcetylSalicylic acid (ASA) (150mg/24h) until 36 weeks of pregnancy, if there is not a contraindication. All data from eligible patients will be analyzed. A bivariant statistical analysis will be performed in order to assess the relationship between dependent variables (diagnose of PE and/or IUGR) and the other variables included in this study

Being tested
Pregnant women
Keywords
Preeclampsia, Screening
Medical subject headings
Pre-Eclampsia, Pregnancy Complications

What participants receive

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

  • Pregnant womenOther

    All pregnant women that present to the 12-week scan in the Obstetrics Unit

Study groups in NCT04767438
Study groupRoleWhat they receive
Pregnant womenAll singleton pregnancies that present to the 12-week scan in the Obstetrics Unit of the participant hospitals. Singleton pregnancies; Gestational age less than 14 weeks, estimated according to Crown-Rump Length (CRL); Blood sample between 8 and 14 weeks of pregnancy; Patients who accept to participate in the study and sign the informed consent.
Receives: Other: Pregnant women

What is being measured

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

  1. Diagnosis of preeclampsia

    Diagnosis of preeclampsia during pregnancy following the definition of the International Society for the Study of Hypertension in Pregnancy, (ISSHP)

    Measured: 30 weeks

Secondary outcomes (12)
  1. Early-onset Preeclampsia

    Early-onset Preeclampsia: diagnosos before 34 weeks of pregnancy

    Measured: 30 weeks

  2. Severe preeclampsia

    Severe preeclampsia (ISSHP)

    Measured: 30 weeks

  3. Pregnancy-induced hypertension

    Pregnancy-induced hypertension

    Measured: 30 weeks

  4. SGA

    Small for gestational age: birth weight below the 10th percentile

    Measured: 30 weeks

  5. IUGR

    Intrauterine Growth Restriction

    Measured: 30 weeks

  6. Perinatal mortality

    Perinatal mortality (>22 weeks of pregnancy - < 28 days postpartum)

    Measured: 30 weeks

  7. Neonatal acidosis

    Neonatal acidosis (arterial pH <7.10 + base excess >12mEq/L)

    Measured: 30 weeks

  8. Neonatal Intensive Care Unit

    Days of admission in neonatal Intensive Care Unit

    Measured: 16 weeks

  9. Neonatal morbidity

    Significant neonatal morbidity: convulsions, intraventricular haemorrhage > III grade, periventricular leukomalacia, hypoxic-ischemic encephalopathy, abnormal electroencephalogram, necrotizing enterocolitis, acute renal failure (serum creatinine >1.5mg/dL) or heart failure (requiring inotropic agents).

    Measured: 16 weeks

  10. Gestational age at birth

    Gestational age at birth

    Measured: 30 weeks

  11. Type of delivery

    Type of delivery (vaginal, spontaneous or instrumental, cesarean section)

    Measured: 30 weeks

  12. Cost of the analysis of angiogenic and antiangiogenic factors

    The economic cost of the analysis of angiogenic and antiangiogenic factors in euros (PlGF and sFlt-1).

    Measured: 18 months

Timeline

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

  1. First posted23 Feb 2021
  2. Study startMar 2021 (estimated)
  3. Primary completionMar 2022 (estimated)
  4. Study completionSep 2022 (estimated)

Resources

More details

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

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
6,560 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04767438
Sponsor's protocol ID
CRISP
Acronym
CRISP
Status last verified
Feb 2021
First submitted
19 Feb 2021
Last updated
23 Feb 2021
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Publications

  • Duley L. The global impact of pre-eclampsia and eclampsia. Semin Perinatol. 2009 Jun;33(3):130-7. doi: 10.1053/j.semperi.2009.02.010.

    PubMed 19464502
  • Melchiorre K, Wormald B, Leslie K, Bhide A, Thilaganathan B. First-trimester uterine artery Doppler indices in term and preterm pre-eclampsia. Ultrasound Obstet Gynecol. 2008 Aug;32(2):133-7. doi: 10.1002/uog.5400.

    PubMed 18615872
  • Lisonkova S, Sabr Y, Mayer C, Young C, Skoll A, Joseph KS. Maternal morbidity associated with early-onset and late-onset preeclampsia. Obstet Gynecol. 2014 Oct;124(4):771-781. doi: 10.1097/AOG.0000000000000472.

    PubMed 25198279
  • Bellamy L, Casas JP, Hingorani AD, Williams DJ. Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis. BMJ. 2007 Nov 10;335(7627):974. doi: 10.1136/bmj.39335.385301.BE. Epub 2007 Nov 1.

    PubMed 17975258
  • von Beckerath AK, Kollmann M, Rotky-Fast C, Karpf E, Lang U, Klaritsch P. Perinatal complications and long-term neurodevelopmental outcome of infants with intrauterine growth restriction. Am J Obstet Gynecol. 2013 Feb;208(2):130.e1-6. doi: 10.1016/j.ajog.2012.11.014. Epub 2012 Nov 15.

    PubMed 23159694
  • Melamed N, Klinger G, Tenenbaum-Gavish K, Herscovici T, Linder N, Hod M, Yogev Y. Short-term neonatal outcome in low-risk, spontaneous, singleton, late preterm deliveries. Obstet Gynecol. 2009 Aug;114(2 Pt 1):253-260. doi: 10.1097/AOG.0b013e3181af6931.

    PubMed 19622985
  • Escobar GJ, Clark RH, Greene JD. Short-term outcomes of infants born at 35 and 36 weeks gestation: we need to ask more questions. Semin Perinatol. 2006 Feb;30(1):28-33. doi: 10.1053/j.semperi.2006.01.005.

    PubMed 16549211
  • Phipps EA, Thadhani R, Benzing T, Karumanchi SA. Pre-eclampsia: pathogenesis, novel diagnostics and therapies. Nat Rev Nephrol. 2019 May;15(5):275-289. doi: 10.1038/s41581-019-0119-6.

    PubMed 30792480
  • Flint EJ, Cerdeira AS, Redman CW, Vatish M. The role of angiogenic factors in the management of preeclampsia. Acta Obstet Gynecol Scand. 2019 Jun;98(6):700-707. doi: 10.1111/aogs.13540. Epub 2019 Feb 22.

    PubMed 30667052
  • 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
  • Roberge S, Bujold E, Nicolaides KH. Aspirin for the prevention of preterm and term preeclampsia: systematic review and metaanalysis. Am J Obstet Gynecol. 2018 Mar;218(3):287-293.e1. doi: 10.1016/j.ajog.2017.11.561. Epub 2017 Nov 11.

    PubMed 29138036
  • Wright D, Rolnik DL, Syngelaki A, de Paco Matallana C, Machuca M, de Alvarado M, Mastrodima S, Tan MY, Shearing S, Persico N, Jani JC, Plasencia W, Papaioannou G, Molina FS, Poon LC, Nicolaides KH. Aspirin for Evidence-Based Preeclampsia Prevention trial: effect of aspirin on length of stay in the neonatal intensive care unit. Am J Obstet Gynecol. 2018 Jun;218(6):612.e1-612.e6. doi: 10.1016/j.ajog.2018.02.014. Epub 2018 Mar 2.

    PubMed 29505771
  • Roberge S, Villa P, Nicolaides K, Giguere Y, Vainio M, Bakthi A, Ebrashy A, Bujold E. Early administration of low-dose aspirin for the prevention of preterm and term preeclampsia: a systematic review and meta-analysis. Fetal Diagn Ther. 2012;31(3):141-6. doi: 10.1159/000336662. Epub 2012 Mar 21.

    PubMed 22441437
  • Bujold E, Roberge S, Lacasse Y, Bureau M, Audibert F, Marcoux S, Forest JC, Giguere Y. Prevention of preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy: a meta-analysis. Obstet Gynecol. 2010 Aug;116(2 Pt 1):402-414. doi: 10.1097/AOG.0b013e3181e9322a.

    PubMed 20664402
  • Rolnik DL, O'Gorman N, Roberge S, Bujold E, Hyett J, Uzan S, Beaufils M, da Silva Costa F. Early screening and prevention of preterm pre-eclampsia with aspirin: time for clinical implementation. Ultrasound Obstet Gynecol. 2017 Nov;50(5):551-556. doi: 10.1002/uog.18899. No abstract available.

    PubMed 28887883

Questions about this trial

What is this clinical trial studying?

An observational study of Pre-Eclampsia and Pregnancy Complications, run by Instituto de Investigación Sanitaria Aragón.

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 4 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: status not confirmed, as of the sponsor's last update on 23 Feb 2021. Status can change between updates, so confirm with the study contact before making plans.

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?

Results are not available in the source record.

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

Contact Daniel Oros, PhD (0034616612323, danoros@unizar.es), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Diagnosis of preeclampsia (time frame: 30 weeks). 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 NCT04767438, which also lists 28 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 23 Feb 2021.

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