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Preeclampsia Screening Taking Into Account Ethnicity and Socioeconomic Status-A Comparison of the Competing Risks
Anastasija Arechvo1, Argyro Syngelaki1, Ranjit Akolekar2
1Fetal Medicine Research Institute, King's College Hospital, London, United Kingdom; Institute of Women and Children's Health, School of Life Course and Population Sciences, King's College London, United Kingdom.
Journal of Obstetrics and Gynaecology Canada : JOGC = Journal D'Obstetrique Et Gynecologie Du Canada : JOGC
|September 3, 2025
Summary
The Fetal Medicine Foundation (FMF) model shows similar pre-eclampsia (PE) detection to risk factor screening but with a lower screen-positive rate (SPR). This improved screening occurs early in pregnancy, aiding timely aspirin treatment for preterm PE prevention.
Area of Science:
- Maternal-fetal medicine
- Obstetrics and Gynecology
- Epidemiology
Background:
- Pre-eclampsia (PE) screening is crucial for timely intervention.
- Current screening methods include clinical risk factors and multivariable models.
- Optimizing screening strategies can improve maternal and fetal outcomes.
Purpose of the Study:
- To compare the performance of the Fetal Medicine Foundation (FMF) multivariable competing-risks model against traditional clinical risk factors for pre-eclampsia (PE) screening.
- To evaluate the effectiveness of the FMF model and a modified National Institute for Health and Care Excellence (NICE) approach in detecting both preterm and term PE.
Main Methods:
- Prospective cohort study of singleton pregnancies delivering at ≥24 weeks.
- Comparison of FMF model with NICE guidance and a 'NICE-modified' approach including Black ethnicity and social deprivation (Index of Multiple Deprivation [IMD] deciles 1-4).
- Screening strategies were matched for screen-positive rate (SPR) to enable direct comparison of detection rates (DR).
Main Results:
- At 11-13 weeks, the FMF model (SPR 7.4%) achieved a similar detection rate (DR 67.7%) for preterm PE as NICE-modified screening (SPR 40.1%, DR 67.4%), but with a significantly lower SPR.
- At 35-36 weeks, the FMF model (SPR 10.9%) demonstrated a higher DR (70.5%) for subsequent PE compared to NICE-modified screening (SPR 37.4%, DR 61.5%).
- The FMF model showed improved detection, particularly among Black women and across different socioeconomic statuses.
Conclusions:
- The FMF model offers comparable pre-eclampsia risk detection to traditional risk factor-based screening.
- The FMF model achieves this with a substantially lower screen-positive rate, especially at 11-13 weeks for preterm PE prevention with aspirin.
- This enhanced screening at both early and late gestation aids in timely interventions for both preterm and term pre-eclampsia.
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