First-trimester pre-eclampsia screening and adverse pregnancy outcomes beyond pre-eclampsia

Area of Science:

• Maternal-fetal medicine
• Obstetrics
• Perinatal outcomes

Background:

• First-trimester screening for pre-eclampsia identifies high-risk pregnancies.
• Aspirin is commonly prescribed to high-risk individuals.
• The association between high-risk screening status and other adverse outcomes requires further investigation.

Purpose of the Study:

• To evaluate if first-trimester high-risk screening for pre-eclampsia predicts adverse pregnancy outcomes beyond pre-eclampsia itself.
• To assess the association between Fetal Medicine Foundation (FMF) screening results and outcomes like preterm birth and fetal growth restriction.
• To determine if increased surveillance is warranted for screen-positive individuals.

Main Methods:

• Retrospective cohort study of 1623 ethnically Chinese women.
• Utilized Fetal Medicine Foundation (FMF)-based first-trimester pre-eclampsia screening.
• Compared outcomes between screen-positive (high-risk, aspirin) and screen-negative groups, adjusting for pre-eclampsia and pregnancy hypertension.

Main Results:

• Screen-positives had significantly earlier delivery (-0.7 weeks) and higher rates of preterm birth (OR 2.413).
• Lower birth weight percentiles (-8.3) and increased small-for-gestational-age (SGA) (OR 2.697) were observed in screen-positives.
• Higher rates of emergency cesarean (OR 2.943), NICU admission (OR 2.044), and stillbirth (OR 5.131) were noted in the screen-positive group.

Conclusions:

• First-trimester FMF screening identifies a higher risk for SGA/fetal growth restriction and preterm birth, independent of pre-eclampsia.
• These findings suggest that FMF screening identifies a broader placental-risk phenotype.
• Increased surveillance for screen-positive individuals is recommended, though effective prevention strategies for SGA and spontaneous PTB remain a challenge.