First-Trimester Screening Using a Fetomaternal Calculator Versus Maternal History-Based Screening for the Prevention...

Preeclampsia (PE) is a major contributor to maternal and perinatal morbidity in India. While traditional history-based screening is standard, it often lacks sensitivity. This study evaluates the effectiveness of the Fetal Medicine Foundation (FMF) calculator-based screening, utilizing a multi-parametric approach without biochemical markers, against traditional maternal history-based screening in a North Indian population.

A prospective observational study was conducted at Dr. Baba Saheb Ambedkar Medical College and Hospital (September 2022 to May 2023). Four hundred women at 11 to 13⁺⁶ weeks gestation (crown-rump length (CRL) 45-84 mm) were randomized into Group A (FMF calculator-based screening using maternal history, mean arterial pressure (MAP), and uterine artery pulsatility index (UtA-PI)) and Group B (maternal history-based screening). High-risk cases (Group A cutoff: ≥1 in 150) received 150 mg of aspirin daily until 36 weeks.

The incidence of preterm PE was significantly lower in Group A (9, 4.9%), compared to Group B (23, 12.4%) (p = 0.011). The total PE incidence was 14 (7.6%) in Group A and 34 (18.3%) in Group B (p = 0.002). Among women initially classified as low risk, 24 (16.0%) in the history-based group developed PE compared with six (4.3%) in the calculator group (p = 0.001). Group A also showed a significant reduction in NICU admissions, i.e., 14 (7.6%) versus 28 (15.1%) in Group B (p = 0.025).

First-trimester screening using the FMF calculator without biochemical markers is significantly more effective than history-based checklists. This protocol facilitates a viable, resource-based screening strategy for low- and middle-income countries.