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First trimester pre-eclampsia screening using FMF-UtA-PAPPA algorithm in Hong Kong: A low-cost alternative to PlGF
Suet Yin Ho1, Linus Lin Tai Lee1, Lin Wai Chan1
1Department of Obstetrics and Gynaecology, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong.
Taiwanese Journal of Obstetrics & Gynecology
|April 26, 2026
Summary
The Fetal Medicine Foundation-UtA-PAPPA screening method significantly improves preeclampsia detection rates compared to the NICE approach. This enhanced screening identifies more high-risk pregnancies, enabling timely intervention to prevent adverse maternal and fetal outcomes.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Diagnostic Screening
Background:
- Preeclampsia (PE) poses significant risks to maternal and fetal well-being.
- Current screening methods, like the National Institute for Health and Care Excellence (NICE) approach, have limitations in detection rates.
- First-trimester screening offers a critical window for early intervention.
Purpose of the Study:
- To compare the effectiveness of Fetal Medicine Foundation-based first-trimester preeclampsia screening (FMF-UtA-PAPPA) against the NICE approach.
- To evaluate screening performance in a predominantly East Asian population within a public, non-academic healthcare setting.
- To assess the impact of improved PE detection on maternal-fetal outcomes.
Main Methods:
- A retrospective study of 1860 pregnancies screened between May 2022 and December 2023.
- Application of the FMF-UtA-PAPPA screening protocol (maternal factors, MAP, uterine artery Doppler, PAPP-A).
- Retrospective application of the NICE criteria and adjustments for aspirin use in preterm PE.
Main Results:
- FMF-UtA-PAPPA demonstrated superior detection rates for both preterm PE (80% vs. 55%) and total PE (67.8% vs. 45.8%) compared to the NICE approach (p < 0.05).
- Preterm PE cases were associated with significantly poorer fetal outcomes: earlier gestational age (32.3 vs. 38.8 weeks), lower birth weight (1499 vs. 3044 g), and increased neonatal unit admission (66.7% vs. 15.4%).
- The FMF-UtA-PAPPA approach identified more high-risk pregnancies eligible for low-dose aspirin therapy.
Conclusions:
- The FMF-UtA-PAPPA first-trimester screening is more effective than the NICE approach for preeclampsia detection in this population.
- This cost-effective screening method, without requiring laboratory investment, can significantly reduce preterm PE incidence and associated complications.
- Implementing FMF-UtA-PAPPA screening can lead to improved maternal and fetal health outcomes through early identification and management of high-risk pregnancies.
