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

OBJECTIVE: To determine if those screened as high-risk for preterm pre-eclampsia at first-trimester Fetal Medicine Foundation (FMF)-based screening and given aspirin are at higher risk of adverse pregnancy outcomes, even after adjusting for pre-eclampsia. METHODS: This retrospective cohort study included 1623 ethnically Chinese women who received FMF-based pre-eclampsia screening, and subsequently delivered within our hospital system. Pregnancy outcomes were compared between screen-positives (high risk, given aspirin) and screen-negatives, and adjusted by pre-eclampsia status and any hypertension in pregnancy. RESULTS: After adjustment for pre-eclampsia, screen-positives still delivered earlier (-0.7 weeks, P < 0.001), with a higher rate of preterm birth (PTB) before 37 weeks (odds ratio [OR] 2.413, P = 0.002). Birth weight centiles in the screen-positive group were lower (-8.3, P = 0.001), with small-for-gestational-age (SGA) being more common in the screen-positive group (OR 2.697, P < 0.001). Emergency cesarean was more common (OR 2.943, P < 0.001), rate of admission to neonatal intensive care unit was higher (OR 2.044, P = 0.014), and stillbirths were more common (OR 5.131, P = 0.038). CONCLUSION: The risks for SGA/fetal growth restriction and PTB were significantly higher in those who screened positive at FMF first-trimester pre-eclampsia screening, even after adjusting for pre-eclampsia, and they may benefit from increased surveillance. Components of FMF-based first-trimester pre-eclampsia screening overlap substantially with uteroplacental great obstetrical syndromes, and help to identify a broader placental-risk phenotype. Future research may explore how this information could be further operationalized-through refinement of risk thresholds and incorporation of adjunctive strategies. Nevertheless, the lack of highly effective strategies to further stratify and prevent SGA/fetal growth restriction and spontaneous PTB remains a challenge.