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.

Objectives: To examine the association between racial origin and preeclampsia(PE) and gestational hypertension(GH) after adjustment for factors in maternal characteristics and medical history in screening study from the Fetal Medicine Foundation (FMF) in England, and to perform a systematic review and meta-analysis of studies on PE. Methods: In the FMF data regression analysis was performed to examine the association between racial origin and PE or GH. Literature search to December 2021 was carried out to identify peer-reviewed publications on race and PE. Main outcome measure: Relative risk of PE and GH in women of black, South Asian and East Asian racial origin by comparison to white women. Results: In the FMF study there were 168,966 singleton pregnancies without major abnormalities delivering at ≥24 weeks’ gestation. In black women the respective risk of total-PE and preterm-PE was 2-fold and 2.5-fold higher and risk of GH was 25% higher, in South Asian women there was a 1.5-fold higher risk of preterm-PE but not total-PE, and in East Asian women there was no significant difference in risk of hypertensive disorders. The literature search identified 19 studies that provided data on several million of pregnancies, but 17 were at moderate or high-risk of bias and only three provided risks adjusted for some maternal characteristics; consequently, these studies did not provide accurate contribution of different racial groups to the prediction of PE. Conclusion: In women of black and South Asian origin the risk of PE, after adjustment for confounders, is higher than in white women