Optimising Pre-Eclampsia Screening in Black Women; a Secondary Analysis of Data from Non-Intervention Screening Studies.

OBJECTIVE

To compare pre-eclampsia screening strategies among Black vs. White ethnicity women.

METHODS

Using data from prospective non-intervention cohort studies in Europe, we evaluated pre-eclampsia risk in singleton pregnancies. Risk was determined by clinical risk factor screening ('clinical'), 'clinical' with Black ethnicity as a moderate-risk factor ('clinical-modified'), and the Fetal Medicine Foundation competing-risks model at 11-13 weeks' gestation ('model11-13 ' for preterm pre-eclampsia) and 35-36 weeks ('model35-36 ' for late preterm/term pre-eclampsia). To compare screening performance, models' screen-positive rates were adjusted to match 'clinical' screening.

RESULTS

At 11-13 weeks, 61,174 pregnancies were screened; preterm pre-eclampsia occurred in 493 (0.8%). At an overall 11.2% screen-positive-rate, 'model11-13 ' (vs. 'clinical') detection of preterm pre-eclampsia almost doubled for Black (88.0% from 46.4%) and White (66.4% from 36.7%) women. For 'clinical-modified', the overall screen-positive-rate was 18.5% and the detection rate for 'model11-13 ' (vs. 'clinical-modified') was 94.0% from 85.0% for Black women, and 77.3% from 36.7% for White. At 35-36 weeks, 29,035 pregnancies were screened; subsequent pre-eclampsia occurred in 654 (2.3%). At an overall 10.9% screen-positive-rate, 'model35-36 ' (vs. 'clinical') detection of pre-eclampsia more than doubled for both Black (74.8% from 26.2%) and White (69.6% from 33.1%) women. For 'clinical-modified', the overall screen-positive-rate was 15.5% and the detection rate for 'model35-36 ' (vs. 'clinical-modified') was 84.1% from 85.0% for Black women, and 78.5% from 33.1% for White.

CONCLUSIONS

The screening performance of the competing-risks model is superior to that of clinical risk factor screening without and with addition of Black ethnicity as a moderate clinical risk factor.