Preeclampsia Screening Taking Into Account Ethnicity and Socioeconomic Status—A Comparison of the Competing Risks Model and Risk Factor Scoring

Objectives

This study aimed to compare preeclampsia (PE) risk screening by risk factors and the multivariable competing risks model.

Methods

This prospective cohort study enrolled singleton pregnancies, without major anomalies, and delivering at ≥24 weeks. PE risk was compared between the Fetal Medicine Foundation (FMF) model and clinical risk factors by National Institute for Health and Care Excellence (NICE) guidance, U.K. and “NICE-modified” by adding Black ethnicity and social deprivation (index of multiple deprivation deciles 1–4) as moderate risk factors. To compare screening strategies, we matched the FMF screen-positive rate (SPR) to NICE.

Results

At 11–13 weeks, preterm PE risk was assessed in 44 813 pregnancies; 368 (0.8%) developed preterm PE. At SPR = 7.4%, FMF (vs. NICE) almost tripled preterm PE detection rate (DR) but by more (by 19.8%) among Black women. The FMF model at SPR = 7.4% had DR = 67.7% for preterm PE, similar to NICE-modified screening (67.4%, which had SPR = 40.1%). At 35–36 weeks, subsequent PE risk was assessed in 29 035 pregnancies; 654 (2.3%) developed PE. At SPR = 10.9%, FMF (vs. NICE) more than doubled subsequent PE DR, regardless of index of multiple deprivation or Black ethnicity. FMF at SPR = 10.9% had DR for subsequent PE at least as high (70.5%) as NICE-modified screening (61.5%), which had SPR = 37.4%.

Conclusions

The FMF model detects PE risk similar to risk factor–based screening, with addition of Black ethnicity and social deprivation as moderate risk factors but at substantially lower SPR at 11–13 weeks when aspirin is offered to prevent preterm PE and at 35–36 weeks when timed birth at term may prevent term PE.