Objective: To compare pre-eclampsia (PE) risk strategies among Black vs. White ethnicity women. Design: Prospective non-intervention cohort studies. Setting: Maternity hospitals, United Kingdom and Europe. Population: Singleton pregnancies delivering at ≥24 weeks, without major anomalies. Methods: PE risk was determined by National Institute for Health and Care Excellence (NICE) guidance, NICE guidance modified adding Black ethnicity as a moderate-risk factor, and the Fetal Medicine Foundation (FMF) competing-risks multivariable model. To compare model performance, the FMF screen-positive rate (SPR) was adjusted to match NICE. Results: At 11-13 weeks, screening for preterm PE risk occurred in 61,174 pregnancies; 493 (0.8%) developed preterm PE. At SPR=11.2%, FMF (vs. NICE) almost doubled the DR for preterm PE for Black (88.0%) vs. White (66.4%) women, but DR increased more among Black women (14.7%, 95% confidence interval [CI] 5.6-23.6). For NICE-modified, the preterm PE DR increased (85.2%), similar to FMF (89.6%), but SPR was higher (59.6% vs. 27.7%, respectively). At 35-36 weeks, screening for subsequent PE occurred in 29,035 pregnancies; 654 (2.3%) developed PE. At SPR=10.9%, FMF (vs. NICE) more than doubled the DR for subsequent PE, and DR increased more among Black vs. White women (12.1%, 95% CI 1.9-22.3). For NICE-modified, the PE DR increased (85.0%), similar to FMF (74.8%), but SPR was higher (59.1% vs. 17.6%, respectively). Conclusions: The FMF competing-risks models increased the DR for PE, particularly amongst Black women. While DRs similar to FMF were seen with addition to NICE of Black ethnicity as a moderate-risk factor, SPR was two-to-three times higher.

Objective: To investigate the effects of aspirin on the distribution of birthweight and its impact on the rates of large-for-gestational age (LGA) neonates. Design: Secondary analysis of the Combined Multimarker Screening and Randomized Patient Treatment with Aspirin for Evidence-based Preeclampsia Prevention (ASPRE) trial. Setting: Thirteen hospitals in England, Spain, Belgium, Greece, Italy, and Israel. Population: Participants of the ASPRE trial at increased risk of preterm pre-eclampsia (PE) who had a live birth. Methods: We compared the birthweight distributions and the rates of LGA neonates between the trial groups. Analyses were stratified according to the presence of pre-existing diabetes mellitus and the development of pre-eclampsia, and logistic regression was used to investigate independent predictors of LGA neonates. Main Outcome Measures: Birthweight distribution and rate of LGA neonates. Results: Among 1,571 singleton, live neonates (777 from the aspirin group and 794 from the placebo group), aspirin was associated with a shift in birthweight from below 2,500 to between 2,500 and 4,000 grams, and birthweight percentile from below the 25 th to between the 25 th and 75 th percentiles, with no significant increase in LGA neonates (5.5% vs. 6.2%, p=0.667). Logistic regression demonstrated a significant interaction between treatment and pre-existing diabetes (p-value 0.034), and a positive association between maternal weight and LGA neonates (adjusted odds ratio 1.040, 95% confidence interval 1.030 – 1.051, p<0.001). Conclusions: Aspirin use is associated with increased birthweight without increasing the rate of LGA neonates. Among women with pre-existing diabetes, however, aspirin may lead to a higher rate of LGA neonates.

Objectives: To investigate the association and the potential value of prelabour fetal heart rate short-term variability (STV) determined by computerised cardiotocography (cCTG) and maternal-foetal Dopplers in predicting labour outcomes. Design: Prospective cohort study. Setting: The Prince of Wales Hospital, a tertiary maternity unit, in Hong Kong SAR. Population: Women with a term singleton pregnancy in latent phase of labour or prior to labour induction were recruited during May 2019 – November 2021. Methods: Ultrasonographic assessment of foetal growth, Doppler velocimetry and the cCTG monitoring including Dawes-Redman CTG analysis. Main Outcome Measures: Umbilical Cord arterial pH, emergency delivery due to pathological CTG during labour and neonatal intensive care unit (NICU)/special care baby unit (SCBU) admission. Results: Of the 400 cases, 34 (8.5%) women underwent emergency delivery for pathological CTG during labour. A total of 6 (1.50%) and 148 (37.00%) newborns required NICU and SCBU admission, respectively. Middle cerebral artery pulsatility index (MCA-PI) and MCA-PI z-score were significant lower in pregnancies that required emergency delivery for pathological CTG during labour compared with those who did not [1.23 (1.07-1.40) vs 1.40 (1.22-1.64), p=0.002 and 0.55 (±1.07) vs 0.12 (±1.06), p=0.049,]. Umbilical cord arterial pH was associated with STV (r = 0.107, p = 0.035) and the independent predictors for umbilical cord arterial pH were smoking (p = 0.006) and STV (p = 0.025). Conclusions: In pregnant women admitted in latent phase of labour or for induction of labour at term, cCTG STV is associated with umbilical cord arterial pH but not predictive of emergency delivery due to pathological CTG during labour.

Objective: To determine the presence of anti-SARS-CoV-2 antibodies in colostrum and mature milk in women who had SARS-CoV-2 infection during pregnancy or at delivery; to investigate the correlation between anti-SARS-CoV-2 antibodies in milk with antibody in maternal blood, severity of infection and time-interval from active illness; and to evaluate immunoglobulin evolution from colostrum to mature milk. Design: prospective cohort-study Setting: six hospitals in Spain and Hong-Kong. Sample: pregnant women with confirmed SARS-CoV-2 infection during pregnancy or at delivery. Methods: Colostrum and mature milk were collected by manual expression with strict contact precautions. Colostrum samples were tested with rRT-PCR-SARS-CoV-2 and both, maternal milk and serum were tested against SARS-CoV-2 specific immunoglobulin M, A and G reactive to receptor binding domain of SARS-CoV-2 spike protein-1. Results: All rRT-PCR-SARS-CoV-2 tested negative. IgA and IgG were present in 111/135 (82.2%) and 2/135 (1.5%) colostrum samples and 27/81 (33.3%) and 0/81 mature milk samples, respectively. Concentrations of immunoglobulins were not associated with the timing of infection but women with SARS-CoV-2 pneumonia had higher levels of IgA and IgG in colostrum than those who were asymptomatic or had mild symptoms. Conclusion: No SARS-CoV-2 virus was found in human milk, however, high levels of antibodies were found in colostrum, specially IgA, irrespective of the time of infection. All women should be encouraged to breastfeed, undertaking strict contact precautions when there is active disease. Funding: Spanish Government grant (Instituto de Salud Carlos III: COV20/00188). Synlab Diagnostics’ Globales (Madrid, Spain). Perkin Elmer.

Objectives: To assess whether adding placental growth factor (PlGF) or replacing pregnancy-associated plasma protein-A (PAPP-A) improves the first trimester combined test performance for trisomy 21. Design: Prospective observation Cohort Setting: The Chinese University of Hong Kong, China Sample: 11,518 women having a singleton pregnancy screened for trisomy 21 between December 2016 and December 2019 using the first trimester combined test. Methods: PlGF was prospectively measured and estimated term risk for trisomy 21 was calculated by 1) replacing PAPP-A with PlGF and 2) adding PlGF to the combined test which includes nuchal translucency, PAPP-A and free β-human chorionic gonadotropin (hCG). Main Outcome Measure: Screening performance, area under curve (AUC), detection rate (DR), screen positive rate (SPR) and false positive rate (FPR) Results: 29 women had trisomy 21. The combined tests DR, FPR and SPR were 89.7%, 5.7% and 6% respectively. DR when replacing PAPP-A or adding PlGF to the combined test remained unchanged. Replacing PAPP-A by PlGF increased FPR and SPR to 6.2% and 6.4% respectively. Adding PlGF to the combined test gave FPR and SPR rates of 5.5% and 5.7% respectively. Adding or replacing PlGF did not give a significant increase in AUC (p>0.48) over that of the combined test. Conclusion: Adding PlGF to the combined test or replacing PAPP-A with PlGF in the combined test did not improve trisomy 21 detection rate. Replacing PAPP-A by PlGF increased SPR, whilst adding PlGF resulted in only a marginal reduction in SPR.