Nishan Lamichhane, Shengxin Liu, Agneta Wikman, Marie Reilly
{"title":"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。","authors":"Nishan Lamichhane, Shengxin Liu, Agneta Wikman, Marie Reilly","doi":"10.1097/EDE.0000000000001794","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>The model provided an accurate estimate of positive tests at the 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% of the cost incurred by the excess adverse pregnancy outcomes.</p><p><strong>Conclusion: </strong>Investment in routine second screening can identify many alloimmunizations that currently go undetected or are detected late, with the potential for cost savings.</p>","PeriodicalId":11779,"journal":{"name":"Epidemiology","volume":" ","pages":"40-47"},"PeriodicalIF":4.7000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Potential of a Second Screening Test for Alloimmunization in Pregnancies of Rhesus-positive Women: A Swedish Population-based Cohort Study.\",\"authors\":\"Nishan Lamichhane, Shengxin Liu, Agneta Wikman, Marie Reilly\",\"doi\":\"10.1097/EDE.0000000000001794\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>The model provided an accurate estimate of positive tests at the 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% of the cost incurred by the excess adverse pregnancy outcomes.</p><p><strong>Conclusion: </strong>Investment in routine second screening can identify many alloimmunizations that currently go undetected or are detected late, with the potential for cost savings.</p>\",\"PeriodicalId\":11779,\"journal\":{\"name\":\"Epidemiology\",\"volume\":\" \",\"pages\":\"40-47\"},\"PeriodicalIF\":4.7000,\"publicationDate\":\"2025-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Epidemiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/EDE.0000000000001794\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/9/24 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Epidemiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/EDE.0000000000001794","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/9/24 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH","Score":null,"Total":0}
Potential of a Second Screening Test for Alloimmunization in Pregnancies of Rhesus-positive Women: A Swedish Population-based Cohort Study.
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 the 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% of 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.
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.