Adverse pregnancy outcomes in women at increased risk of preterm pre-eclampsia on first-trimester combined screening

Objective: Uteroplacental dysfunction may not only result in pre-eclampsia (PE) but also in preterm birth (PTB), small- for-gestational -age (SGA) birth and stillbirth. The aim of this study is to evaluate the positive predictive value (PPV) of first-trimester combined PE screening for all of these placenta-mediated adverse pregnancy outcomes.Design: Retrospective cohort study.Setting: Tertiary referral maternity unit.Sample: A total of 13 211 singleton pregnancies.Methods: First-trimester combined screening for preterm PE using the Fetal Medicine Foundation (FMF) algorithm.Main outcomes measures: Hypertensive disorders of pregnancy (HDP), PTB, SGA birth and stillbirth were combined to assess composite adverse and severe adverse pregnancy outcomes (CAPO and CAPO- S). The PPVs for CAPO and CAPO- S were calculated for women with a combined risk for preterm PE of >_1 in 50 and >_1 in 100.Results: First-trimester combined screening identified 2215 women (16.8%) with a risk of >_1 in 100 for preterm PE. The PPVs for a risk of >_1 in 100 for CAPO and CAPO- S were 38.8% and 18.2%, respectively. The equivalent PPVs for a risk of >_1 in 50 were 45.1% and 21.1%, respectively.Conclusions: Women identified at high risk of preterm PE are also at increased risk of other placenta-mediated adverse pregnancy outcomes, such as PTB, SGA birth and stillbirth. Women at high risk for preterm PE after first-trimester screening may benefit from a higher surveillance care pathway, with interventions to mitigate all the adverse outcomes associated with placental dysfunction.