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.