Pre-eclampsia risk-stratified planned birth at term: A survey of women's perspectives on acceptability and risk communication.

INTRODUCTION

Pre-eclampsia (PE) remains a major complication of pregnancies, globally, and while there is no intervention proven to be effective in decreasing late preterm and term PE; the PREVENT-PE trial aimed to evaluate whether the intervention-a strategy of screening for PE risk at 35-36 weeks' gestation, and for a risk of ≥1-in-50, offering risk-stratified, planned early term birth-could reduce the incidence of subsequent PE, compared with usual care.

MATERIAL AND

METHODS

We aimed to evaluate the acceptability of trial participation and risk communication for women participating in The PREVENT-PE trial [ISRCTN41632964] in the United Kingdom. From March to October 2024, trial participants were invited, antenatally and/or postnatally, to complete an online survey, and acceptability and risk communication measures were compared by trial arm.

RESULTS

Of those accessing the survey, 257 out of 478 (48.2%) were antenatal (median 35.4 weeks' gestation), and 485 out of 1617 (30.0%) were postnatal (median 25.6 weeks postnatally) respondents who were eligible. Antenatally, and by trial arm: (i) most women felt: comfortable with the trial (>70%); participation required little/no effort (>75%; 77.9% [intervention] vs. 91.7% [control], p = 0.05); confident in participation (>75%); the trial was acceptable (≈90%); and PE risk screening was fair (>90%), could reduce chances of becoming seriously ill (>90%), and understood how that could be achieved (>90%); (ii) half disagreed that timed birth for PE would interfere with competing priorities, although 20-30% agreed; (iii) ≥80% of participants felt listened to, were able to ask questions and receive helpful answers, had their preferences considered, had clear on the situation being discussed, and were confident about their decision; and (iv) ≈50% were uncertain about what was going to happen. Postnatally, views were more neutral, without an increase in negativity.

CONCLUSIONS

Findings indicate that women find third-trimester screening for PE and risk-stratified planned early term birth highly acceptable, understand those risks, and the potential to favorably impact their pregnancy outcome.