{"id":"AIBD-1032","title":"Norwegian Institute of Public Health finds that screening with the FMF algorithm probably predicts preterm preeclampsia better than current practice","summary":"The Norwegian Institute of Public Health found that first-trimester screening with an algorithm probably improves prediction of delivery with preeclampsia before week 37 of pregnancy.","date_observed":"2022-12-01","date_basis":"source publication","date_precision":"day","benefit_status":"reported","source_collection":null,"source_entry":null,"account":"The Norwegian Institute of Public Health (FHI) published a health technology assessment of first-trimester screening for preeclampsia on 1 December 2022. Nye metoder, Norway's system for new methods in specialist care, had ordered it. The algorithm combines maternal characteristics, mean arterial pressure, uterine artery Doppler and the PlGF protein in the mother's blood. FHI's full report names it as the Fetal Medicine Foundation's web-based screening algorithm. FHI pooled 16 studies from Asia and Europe. At a fixed specificity of 0.9, the sensitivity for preeclampsia before week 37 was 0.728, with moderate confidence. FHI found that screening with the algorithm probably improves prediction of delivery with preeclampsia before week 37. It estimates that screening, with aspirin for women at high risk, could avoid 173 cases of preterm preeclampsia a year and save the health service about NOK 17 million. FHI found no Norwegian or Scandinavian studies and no data to pool the accuracy of current practice. It traces the algorithm to a competing-risks model developed from data on 58,884 pregnancies and does not call it machine learning.","category":"aggregate result","unexpected":false,"purpose":"The Fetal Medicine Foundation built its first-trimester screening algorithm to calculate each pregnant woman's individual risk of preeclampsia from maternal factors and biomarkers.","system":"Fetal Medicine Foundation (FMF) first-trimester preeclampsia screening algorithm (maternal characteristics, mean arterial pressure, uterine artery pulsatility index and PlGF)","model_version":null,"developer":"Fetal Medicine Foundation","deployer":"Screening studies in Asia and Europe that FHI pooled, with screening proposed for Norway's specialist health service","location":"Studies in Asia and Europe, assessed for Norway","domain":"Healthcare (antenatal screening)","segment":null,"benefit_type":"Improved Task Accuracy","work_activities":["4.A.2.a.4"],"taxonomy_note":null,"registry_ids":{},"ratings":[{"group":"organizational","depth":2,"reason":"In the detection rates that FHI took from a FIGO guide for its model, the algorithm detected 74.8% of preterm preeclampsia against 44.8% for maternal factors, at a screen-positive rate of 10%."},{"group":"personal","depth":null,"reason":"The 173 preterm cases avoided each year are FHI's projection for Norway, which had not introduced the screening."}],"ai_role":{"status":"unassessed","statement":"FHI pooled the algorithm's sensitivity from 16 studies. Its comparison with current practice rests on detection rates from a FIGO guide, since no data allowed a pooled estimate for current practice. FHI writes that the algorithm was developed from data on 58,884 pregnancies and cites a competing-risks model. It does not describe the algorithm as machine learning or artificial intelligence."},"evidence":[{"kind":"assessment report","citation":"Norwegian Institute of Public Health (FHI). First trimester-screening for the development of preeclampsia with the use of an algorithm: a health technology assessment. English summary page, published 1 December 2022.","title":"First trimester-screening for the development of preeclampsia with the use of an algorithm: a health technology assessment","url":"https://www.fhi.no/en/publ/2022/First-trimester-screening-for-the-development-of-preeclampsia-with-the-use-of-an-algorithm/","date":"2022-12-01","written_by":"independent","quote":"We found that screening with an algorithm early in pregnancy: probably improves prediction of the risk of delivery with preeclampsia before week 37 of the pregnancy."},{"kind":"assessment report","citation":"Folkehelseinstituttet. Første trimester-screening for utvikling av preeklampsi med bruk av algoritme: en fullstendig metodevurdering. Rapport 2022, chapter 'Organisatoriske aspekter'.","title":"Første trimester-screening for utvikling av preeklampsi med bruk av algoritme: en fullstendig metodevurdering","url":"https://www.fhi.no/globalassets/dokumenterfiler/rapporter/2022/forste-trimester-screening-for-utvikling-av-preeklampsi-med-bruk-av-algoritme-rapport-2022.pdf","date":"2022-12-01","written_by":"independent","quote":"Utfylling av den nettverksbasert screeningalgoritmen fra Fetal Medicine Foundation (FMF) utgjør grunnlaget for beregning av risiko for preeklampsi."}],"replication":{"produced_by":["Screening at weeks 11 to 14 combined maternal characteristics, mean arterial pressure, uterine artery Doppler and PlGF in the mother's blood.","Women identified at high risk received low-dose aspirin from weeks 11 to 14 in the trial that FHI used for the effect of prophylaxis."],"must_hold":["Aspirin prophylaxis must start before week 16 of pregnancy.","Laboratories must analyze PlGF before the early ultrasound.","Maternity units must reach the algorithm through their electronic patient records."],"echoes":[]},"paired_incident":null,"headline":"*FMF screening algorithm* probably predicts preterm preeclampsia better","metric":"the sensitivity for preeclampsia before week 37 was 0.728","comparator":{"against":"Screening by maternal factors, which FHI assumed to be current Norwegian practice","before":"44,8 (40,5-49,2)","after":"74,8 (70,8-78,5)","basis":"assumed","quote":"Tabell 11 viser deteksjonsrate ved en screen-positive rate på 10% for preterm preeklampsi (< uke 37) ved screening basert på maternelle faktorer og maternelle faktorer i kombinasjon med biomarkører.","url":"https://www.fhi.no/globalassets/dokumenterfiler/rapporter/2022/forste-trimester-screening-for-utvikling-av-preeklampsi-med-bruk-av-algoritme-rapport-2022.pdf"},"later":null,"value":{"amount":"~ NOK 17 million per year","what":"Projected yearly saving for the health service from screening with the algorithm and aspirin prophylaxis","who":"Norwegian health service","estimate":true,"quote":"With a calculated saving of around NOK 97,000 per avoided case, this means a total saving for the health service of ~ NOK 17 million per year.","url":"https://www.fhi.no/en/publ/2022/First-trimester-screening-for-the-development-of-preeclampsia-with-the-use-of-an-algorithm/"},"developer_country":"United Kingdom","deployer_country":"Multiple: United Kingdom, Spain, Italy, Belgium, Greece, Russia, India, China, Japan, Taiwan, Thailand, Singapore","unrated_because":null,"brief_notes":null,"brief":null,"revisions":[{"date":"2026-11-01","change":"Added the record from the finding of the Norwegian Institute of Public Health (Folkehelseinstituttet).","source":"https://www.fhi.no/en/publ/2022/First-trimester-screening-for-the-development-of-preeclampsia-with-the-use-of-an-algorithm/","editor":"AIBD"}],"confidence":"found","shade":"high","claim_status":"Found by an assessment body","claim_basis":"Sources: two independent assessment reports. 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