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.

Pregnancy-related venous thromboembolism risk perception and prevention in risk-averse times – significant change required; a commentaryMagee LA1 , Arya R2, Boag C3, Buxton L4, Coleman MA5, Jivraj F6, Scott R7, Sheen K8, Silverio SA1,9, von Dadelszen P1

Background: Existing reviews of pre-eclampsia determinants have focused on clinical and genetic risk factors. Objective: To evaluate social determinants for pre-eclampsia prevention. Search strategy: Systematic searches were conducted on relevant electronic databases to 31 st July 2023. Selection criteria: Reviews and large cohort studies (≥1,000 participants), published within the last 10 years, reporting quantitative associations between social determinant exposures and pre-eclampsia outcomes. Data collection and analysis: Titles and abstracts and then relevant full-texts were reviewed by two reviewers, independently. Strength of association was evaluated as ‘definite’ (odds ratios [OR] or relative risk [RR] ≥3.00 or <0.33), ‘probable’ (OR or RR 1.50-2.99 or 0.33-0.67), ‘possible’ (OR or RR 1.10-1.49 or 0.68-0.89), or ‘unlikely’ (OR or RR 0.90 - 1.09). Quality of the evidence was high, moderate, low, or very-low, using GRADE. Main results: Twenty-six publications found 22 associations of pre-eclampsia with socioeconomic status, social support/exclusion, healthcare access, and occupational and physical environmental factors. One association (polygamy) was definite (low-quality evidence). Probable associations included: work stress and lack of antenatal care (high-quality evidence); prolonged occupational exposure to whole body vibrations or bending, elevated temperatures beyond seasonal norms, and UV-B radiation exposure (protective factor), all based on moderate-quality evidence; and Asian/Oceanian origins (protective, low-quality evidence). There were 11 possible associations, which did not include education. Conclusion: Our findings support recommendations to address climate change, strengthen occupational protection, and promote early ANC attendance. Social determinants may be indicative of upstream factors (e.g., obesity) that increase likelihood of clinical risk factors for pre-eclampsia incidence and severity.