Implementation of First-trimester Screening and preventiOn of pREeClAmpSia Trial (FORECAST)

NCT ID: NCT03941886

Last Updated: 2023-11-29

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

42454 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-07-31

Study Completion Date

2023-08-15

Brief Summary

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This implementation study aims to evaluate the efficacy, acceptability, and safety of first-trimester screening and prevention for preterm-preeclampsia. It is a multicenter stepped wedge cluster randomized trial including maternity / diagnostic units from ten regions in Asia. The study involves a period where no intervention will take place at all recruiting units, and then at regular intervals, one cluster will be randomized to transit from non-intervention group to intervention group in which first-trimester screening for preterm-preeclampsia by the Bayes based method followed by the commencement of low-dose aspirin in high-risk women.

Detailed Description

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Conditions

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Pre-Eclampsia

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

SEQUENTIAL

This is a stepped wedge cluster-randomized trial. There are total of 7 clusters across Asia. This study involves a period where no intervention will take place at all recruiting units, i.e. routine prenatal care, and then at regular intervals (every 6 weekly), one cluster will be randomized to transit from non-intervention group to intervention group in which first-trimester screening for preterm-preeclampsia by the Bayes based method followed by commencement of low-dose aspirin prophylaxis for high-risk women.
Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Study Groups

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Non-intervention group

Participants receive routine prenatal care

Group Type NO_INTERVENTION

No interventions assigned to this group

Intervention group

Participants receive first-trimester screening for preterm-preeclampsia by the Bayes based method followed by commencement of low-dose aspirin prophylaxis in high-risk women.

Group Type EXPERIMENTAL

Low-dose aspirin in women with high risk of preeclampsia

Intervention Type OTHER

Low-dose aspirin 150-162 mg/night or 100 mg/night if body weight \<40 Kg, from \<15 weeks till 36 weeks or, in the event of early delivery, at the onset of labor

Interventions

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Low-dose aspirin in women with high risk of preeclampsia

Low-dose aspirin 150-162 mg/night or 100 mg/night if body weight \<40 Kg, from \<15 weeks till 36 weeks or, in the event of early delivery, at the onset of labor

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Singleton pregnancy;
* Live fetus;

Exclusion Criteria

* Multiple pregnancy;
* Major fetal defects identified at 11-13 weeks of assessment;
* Non-viable fetus (missed spontaneous abortion or stillbirth).
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Chiu Yee Liona Poon

OTHER

Sponsor Role lead

Responsible Party

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Chiu Yee Liona Poon

Professor (Clinical)

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Liona CY Poon, MD

Role: PRINCIPAL_INVESTIGATOR

Chinese University of Hong Kong

Locations

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Guangzhou Women and Children's Medical Center

Guangzhou, , China

Site Status

Kunming Angel Women & Children Hospital

Kunming, , China

Site Status

Nanjing Drum Tower Hospital

Nanjing, , China

Site Status

Prince of Wales Hospital

Hong Kong, Hong Kong, China, Hong Kong

Site Status

Kwong Wah Hospital

Hong Kong, , Hong Kong

Site Status

Harapan Kita Hospital

Jakarta, , Indonesia

Site Status

Clinical Research Institute of Fetal Medicine

Osaka, , Japan

Site Status

Showa University Hospital

Tokyo, , Japan

Site Status

Japan Society for the Study of Hypertension in Pregnancy

Toyama, , Japan

Site Status

Pusat Perubatan Universiti Kebangsaan Malaysia (UKM) Medical Centre

Bandar Tun Razak, , Malaysia

Site Status

Philippine General Hospital

Manila, , Philippines

Site Status

National University Hospital

Singapore, , Singapore

Site Status

Chang Gung Hospital

Taipei, , Taiwan

Site Status

Taiji Clinic

Taipei, , Taiwan

Site Status

Chulalongkorn University Hospital

Bangkok, , Thailand

Site Status

Siriraj Hospital

Bangkok, , Thailand

Site Status

Maharaj Nakorn Chiang Mai Hospital

Chiang Mai, , Thailand

Site Status

Thammasat University Hospital

Khlong Luang, , Thailand

Site Status

Hanoi Obstetrics & Gynecology Hospital

Hanoi, , Vietnam

Site Status

Countries

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China Hong Kong Indonesia Japan Malaysia Philippines Singapore Taiwan Thailand Vietnam

References

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Geographic variation in the incidence of hypertension in pregnancy. World Health Organization International Collaborative Study of Hypertensive Disorders of Pregnancy. Am J Obstet Gynecol. 1988 Jan;158(1):80-3.

Reference Type BACKGROUND
PMID: 2962500 (View on PubMed)

Steegers EA, von Dadelszen P, Duvekot JJ, Pijnenborg R. Pre-eclampsia. Lancet. 2010 Aug 21;376(9741):631-44. doi: 10.1016/S0140-6736(10)60279-6. Epub 2010 Jul 2.

Reference Type BACKGROUND
PMID: 20598363 (View on PubMed)

Khan KS, Wojdyla D, Say L, Gulmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006 Apr 1;367(9516):1066-1074. doi: 10.1016/S0140-6736(06)68397-9.

Reference Type BACKGROUND
PMID: 16581405 (View on PubMed)

Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists' Task Force on Hypertension in Pregnancy. Obstet Gynecol. 2013 Nov;122(5):1122-1131. doi: 10.1097/01.AOG.0000437382.03963.88. No abstract available.

Reference Type BACKGROUND
PMID: 24150027 (View on PubMed)

Tranquilli AL, Dekker G, Magee L, Roberts J, Sibai BM, Steyn W, Zeeman GG, Brown MA. The classification, diagnosis and management of the hypertensive disorders of pregnancy: A revised statement from the ISSHP. Pregnancy Hypertens. 2014 Apr;4(2):97-104. doi: 10.1016/j.preghy.2014.02.001. Epub 2014 Feb 15. No abstract available.

Reference Type BACKGROUND
PMID: 26104417 (View on PubMed)

National Collaborating Centre for Women's and Children's Health (UK). Hypertension in Pregnancy: The Management of Hypertensive Disorders During Pregnancy. London: RCOG Press; 2010 Aug. Available from http://www.ncbi.nlm.nih.gov/books/NBK62652/

Reference Type BACKGROUND
PMID: 22220321 (View on PubMed)

Committee Opinion No. 638: First-Trimester Risk Assessment for Early-Onset Preeclampsia. Obstet Gynecol. 2015 Sep;126(3):e25-e27. doi: 10.1097/AOG.0000000000001049.

Reference Type BACKGROUND
PMID: 26287789 (View on PubMed)

Wright D, Syngelaki A, Akolekar R, Poon LC, Nicolaides KH. Competing risks model in screening for preeclampsia by maternal characteristics and medical history. Am J Obstet Gynecol. 2015 Jul;213(1):62.e1-62.e10. doi: 10.1016/j.ajog.2015.02.018. Epub 2015 Feb 25.

Reference Type BACKGROUND
PMID: 25724400 (View on PubMed)

O'Gorman N, Wright D, Syngelaki A, Akolekar R, Wright A, Poon LC, Nicolaides KH. Competing risks model in screening for preeclampsia by maternal factors and biomarkers at 11-13 weeks gestation. Am J Obstet Gynecol. 2016 Jan;214(1):103.e1-103.e12. doi: 10.1016/j.ajog.2015.08.034. Epub 2015 Aug 19.

Reference Type BACKGROUND
PMID: 26297382 (View on PubMed)

O'Gorman N, Wright D, Poon LC, Rolnik DL, Syngelaki A, de Alvarado M, Carbone IF, Dutemeyer V, Fiolna M, Frick A, Karagiotis N, Mastrodima S, de Paco Matallana C, Papaioannou G, Pazos A, Plasencia W, Nicolaides KH. Multicenter screening for pre-eclampsia by maternal factors and biomarkers at 11-13 weeks' gestation: comparison with NICE guidelines and ACOG recommendations. Ultrasound Obstet Gynecol. 2017 Jun;49(6):756-760. doi: 10.1002/uog.17455.

Reference Type BACKGROUND
PMID: 28295782 (View on PubMed)

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.

Reference Type BACKGROUND
PMID: 28657417 (View on PubMed)

Plasencia W, Maiz N, Poon L, Yu C, Nicolaides KH. Uterine artery Doppler at 11 + 0 to 13 + 6 weeks and 21 + 0 to 24 + 6 weeks in the prediction of pre-eclampsia. Ultrasound Obstet Gynecol. 2008 Aug;32(2):138-46. doi: 10.1002/uog.5402.

Reference Type BACKGROUND
PMID: 18634131 (View on PubMed)

Poon LC, Zymeri NA, Zamprakou A, Syngelaki A, Nicolaides KH. Protocol for measurement of mean arterial pressure at 11-13 weeks' gestation. Fetal Diagn Ther. 2012;31(1):42-8. doi: 10.1159/000335366. Epub 2012 Jan 13.

Reference Type BACKGROUND
PMID: 22248988 (View on PubMed)

Chen Y, Nguyen-Hoang L, Dinh LT, Nguyen DA, Pooh RK, Shiozaki A, Zheng M, Hu Y, Ma R, Kusuma A, Wataganara T, Choolani MA, Kaneko M, Luewan S, Chang TY, Chaiyasit N, Nanthakomon T, Jiang Y, Shaw SW, Leung WC, Mohamad AS, Aguilar A, Lau SL, Lee NMW, Liu J, Sahota DS, Chong MKC, Papastefanou I, Poon LC. Effect of aspirin on small for gestational age neonates in pregnancies at high-risk for preeclampsia: a secondary analysis of a cluster randomised clinical trial. Lancet Reg Health West Pac. 2025 Jun 5;59:101582. doi: 10.1016/j.lanwpc.2025.101582. eCollection 2025 Jun.

Reference Type DERIVED
PMID: 40529816 (View on PubMed)

Nguyen-Hoang L, Dinh LT, Tai AST, Nguyen DA, Pooh RK, Shiozaki A, Zheng M, Hu Y, Li B, Kusuma A, Yapan P, Gosavi A, Kaneko M, Luewan S, Chang TY, Chaiyasit N, Nanthakomon T, Liu H, Shaw SW, Leung WC, Mahdy ZA, Aguilar A, Leung HHY, Lee NMW, Lau SL, Wah IYM, Lu X, Sahota DS, Chong MKC, Poon LC; FORECAST Collaborators. Implementation of First-Trimester Screening and Prevention of Preeclampsia: A Stepped Wedge Cluster-Randomized Trial in Asia. Circulation. 2024 Oct 15;150(16):1223-1235. doi: 10.1161/CIRCULATIONAHA.124.069907. Epub 2024 Jun 26.

Reference Type DERIVED
PMID: 38923439 (View on PubMed)

Other Identifiers

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2018-0434

Identifier Type: -

Identifier Source: org_study_id