Potential of a second screening test for alloimmunization in pregnancies of Rhesus-positive women: a Swedish population- based cohort study.

IF 4.7 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Nishan Lamichhane, Shengxin Liu, Agneta Wikman, Marie Reilly
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引用次数: 0

Abstract

Introduction: There is lack of consensus regarding whether a second screening in Rhesus-positive pregnant women is worthwhile, with different guidelines, recommendations, and practices. We aimed to estimate the number and timing of missed alloimmunizations in Rhesus-positive pregnancies screened once and weigh the relative burden of additional screening and monitoring versus the estimated reduction in adverse pregnancy outcomes.

Methods: We extracted information on maternal, pregnancy, and screening results for 682,126 pregnancies for 2003-2012 from Swedish national registers. We used data from counties with a routine second screening to develop and validate a logistic model for a positive second test after an earlier negative. We used this model to predict the number of missed alloimmunizations in counties offering only one screening. Interval-censored survival analysis identified an optimal time window for a second test. We compared the burden of additional screening with estimated adverse pregnancy outcomes avoided.

Results: The model provided an accurate estimate of positive tests at second screening. For counties with the lowest screening rates, we estimated that a second screening would increase the alloimmunization prevalence by 33% (from 0.19% to 0.25%), detecting the 25% (304/1222) of cases that are currently missed. The suggested timing of a second screen was gestational week 28.For pregnancies currently screened once, the estimated cost of a second test followed by maternal monitoring was approximately 10% the cost incurred by the excess adverse pregnancy outcomes.

Conclusion: Investment in routine second screening can identify many alloimmunizations that currently go undetected or are detected late, with the potential for cost savings.

对猕猴桃阳性孕妇进行第二次同种免疫筛查试验的潜力:一项基于瑞典人口的队列研究。
导言:关于是否值得对猕猴桃阳性孕妇进行第二次筛查,目前还缺乏共识,存在不同的指南、建议和做法。我们的目的是估算接受过一次筛查的猕猴桃阳性孕妇中错过的同种免疫的数量和时间,并权衡额外筛查和监测的相对负担与不良妊娠结局的估计减少量:我们从瑞典国家登记册中提取了 2003-2012 年间 682,126 例妊娠的孕产妇、妊娠和筛查结果信息。我们利用常规二次筛查县的数据,开发并验证了早期阴性后二次筛查呈阳性的逻辑模型。我们利用该模型预测了只提供一次筛查的县中漏检的同种免疫数量。间隔删失生存分析确定了第二次检测的最佳时间窗口。我们将额外筛查的负担与估计避免的不良妊娠结局进行了比较:结果:该模型准确估计了第二次筛查的阳性检测结果。对于筛查率最低的县,我们估计第二次筛查将使同种免疫患病率增加 33%(从 0.19% 增加到 0.25%),从而发现目前漏检的 25% 的病例(304/1222)。建议第二次筛查的时间为孕 28 周。对于目前接受过一次筛查的孕妇,第二次检测后进行孕产妇监测的估计成本约为不良妊娠结局超标成本的 10%:结论:对常规二次筛查的投资可以发现许多目前未被发现或发现较晚的同种免疫,从而有可能节约成本。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Epidemiology
Epidemiology 医学-公共卫生、环境卫生与职业卫生
CiteScore
6.70
自引率
3.70%
发文量
177
审稿时长
6-12 weeks
期刊介绍: Epidemiology publishes original research from all fields of epidemiology. The journal also welcomes review articles and meta-analyses, novel hypotheses, descriptions and applications of new methods, and discussions of research theory or public health policy. We give special consideration to papers from developing countries.
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