Study reveals repeat pre-eclampsia testing does not improve pregnancy outcomes

A single test used to speed up the diagnosis of a dangerous condition in pregnant women does not need to be repeated, according to new research. The PARROT-2 trial, published today in The Lancet by King’s College London researchers, found that routine repeat placental growth factor-based testing (PIGF) is unnecessary for all women with suspected pre-eclampsia.

PARROT-2 is a large, multi-center UK trial including 1,252 women with suspected preterm pre-eclampsia, a potentially fatal illness for pregnant women and their newborns that can result in serious problems such as stillbirth and neonatal death, as well as extended hospital stays.

PIGF testing is a blood test that detects pre-eclampsia biomarkers such as placental growth factor and soluble flt-1. An abnormal test will identify women and babies at higher risk of adverse outcomes and require intense surveillance, whereas a normal result indicates that women can be safely returned home to continue with usual antenatal care. The use of an initial pregnancy test was rolled out across majority of England in 2021.

The findings suggest that repeat testing resulted in a faster diagnosis of pre-eclampsia, but this did not lead to better outcomes for women or their newborns.

Dr. Alice Hurrell, first author of the study from King’s College London, stated, “This huge trial has significant implications for policy, practice, and guidelines. Our data do not support universal, routine repeat testing, as is proposed by certain international bodies. However, the clinical value of a single placental growth factor-based test when pre-eclampsia is suspected is obvious.”

Professor Lucy Chappell, NIHR Senior Investigator at King’s College London, stated, “Pregnant women consistently tell us how important it is to have higher diagnostic confidence. These trial findings could help to minimize the barriers to widespread equitable adoption of early placental growth factor-based testing, hence improving maternal health outcomes worldwide.

“With an estimated 5% of all women affected by preterm hypertension in pregnancy (around 7 million pregnancies worldwide), this is now a pivotal time to ensure that placental growth factor-based testing can reach widespread implementation across health care settings.”

Marcus Green, CEO of Action on Pre-eclampsia, stated, “These are incredibly important data demonstrating that once the first test is completed, there is little to gain from additional testing. A single test can tell women with confidence whether they are likely or unlikely to develop pre-eclampsia. We look forward to the conclusion of the roll-out of placental growth factor-based testing in England, with an urgent push for implementation in the devolved administrations across all four nations. These new findings also offer a timely chance to address the higher burden of unfavorable outcomes associated with pre-eclampsia in global settings.”

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