Preeclampsia screening taking into account ethnicity and socioeconomic status - a comparison of the competing-risks model and risk factor scoring.

To compare pre-eclampsia risk screening by risk factors and the multivariable competing-risks model. 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, United Kingdom (UK), and 'NICE-modified' by adding Black ethnicity and social deprivation (Index of Multiple Deprivation [IMD] deciles 1-4) as moderate-risk factors. To compare screening strategies, we matched the FMF screen-positive rate (SPR) to NICE. 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 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 IMD 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%. 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. [Abstract copyright: Copyright © 2025. Published by Elsevier Inc.]