36-Week Pre-eclampsia Screening May Reduce Term Risk

A New Preventive Strategy for Term Pre-eclampsia

A major UK randomised trial has introduced promising evidence that 36-week pre-eclampsia screening, combined with risk-stratified planned early-term birth, may offer a safe way to lower term pre-eclampsia rates. Published in The Lancet, the PREVENT-PE trial addresses a long-standing challenge in obstetric care: the lack of effective strategies to prevent pre-eclampsia that develops at term, where most cases occur.

By integrating maternal history, mean arterial pressure, and key biomarkers, this 36-week assessment helps clinicians identify women who are most likely to benefit from early-term delivery. The approach is both practical and acceptable in routine maternity care, showing no increase in emergency Caesarean sections, postpartum pre-eclampsia, or neonatal complications.

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These findings highlight a feasible and patient-centred method that may reshape how high-risk pregnancies are managed in the final weeks of gestation. 

Why Pre-eclampsia Screening Matters

Pre-eclampsia remains a leading hypertensive complication, affecting about 3% of pregnancies and contributing significantly to maternal and perinatal morbidity. Nearly 75% of cases occur at term, where preventive therapies are limited.

The study evaluated whether screening at 36 weeks using the FMF competing-risks model—incorporating maternal history, MAP, and biomarkers (PlGF and sFlt-1), could reliably identify women at elevated risk. Those with a predicted risk ≥1:50 in the intervention arm received personalised timing of birth between 37–40 weeks, depending on their risk level.

Evidence from the PREVENT-PE Trial

The trial included 8,094 singleton pregnancies, with participants randomly assigned before risk assessment. About 78% of the intervention arm were classified as low-risk and continued routine care, while high-risk women were offered planned early-term induction.

The results were clinically meaningful:

• 4% pre-eclampsia rate in the intervention group vs 5.6% in controls
• 30% relative reduction in term pre-eclampsia (ISSHP 2021 criteria)
• No increase in postpartum pre-eclampsia, NICU admissions, emergency Cesarean sections, or serious adverse events (<0.3%)

High participation rates (≈75%) also indicate strong acceptability among pregnant women, and planned economic evaluations may further support policy adoption.

Implications for Clinical Practice

This is the first randomized trial demonstrating that targeted, risk-based planned birth at early term, guided by 36-week pre-eclampsia screening, may reduce term disease safely. The findings could shape future guidelines supporting personalised third-trimester management for women at risk of hypertensive complications.

Source:

The Lancet