TOPLINE:

The risk assessment for term preeclampsia at 36 weeks of gestation and scheduled early-term birth for high-risk women reduced the incidence of subsequent preeclampsia by 30%, without increasing caesarean births or neonatal care unit admissions.

METHODOLOGY:

• Researchers conducted an open-label, adaptive, randomised controlled trial at two maternity hospitals in the UK to evaluate whether planned early-term birth depending on risk stratification for term preeclampsia can reduce the incidence of subsequent preeclampsia.
• They included 8094 women (aged ≥ 16 years) with singleton pregnancies at 35-36 weeks of gestation between May 2023 and June 2024.
• Participants were randomly assigned in a 1:1 ratio to either the intervention group (n = 4037; who underwent the risk assessment for preeclampsia and had risk-stratified planned early-term birth) or the control group (n = 4057; who received usual care at term).
• The primary outcome was birth with preeclampsia according to the International Society for the Study of Hypertension in Pregnancy 2021 criteria; secondary outcomes were caesarean births and neonatal care unit admissions for at least 48 hours.

TAKEAWAY:

• The intervention group had a lower incidence of preeclampsia than the control group (3.9% vs 5.6%), reflecting a 30% relative reduction in the risk (adjusted risk ratio, 0.70; P = .0051).
• The intervention and control groups showed comparable rates of caesarean delivery (22.8% vs 21.6%) and neonatal care unit admissions (6.5% vs 6.8%) for at least 48 hours.
• Among women who were offered risk-stratified planned early-term births, 82.8% adhered to the intervention.
• Serious adverse events were rare and did not differ significantly between the intervention and control groups.

IN PRACTICE:

"This is the first trial to show that a personalised approach to near-term preeclampsia risk assessment can reduce the incidence of disease in the maternity population," the authors wrote.

SOURCE:

This study was led by James Goadsby, MD, and Argyro Syngelaki, PhD, Fetal Medicine Research Institute, King's College Hospital, London, England. It was published online on December 04, 2025, in The Lancet.

LIMITATIONS:

The trial was conducted at two maternity hospitals in the UK where a 36-week birth-plan scan is part of usual care, thus limiting generalisability. The angiogenic markers used for the risk assessment are not widely available in all clinical settings. This study was restricted to singleton pregnancies; hence, the findings cannot be applied to women with multifoetal pregnancies approaching term gestation.

DISCLOSURES:

This study was supported by a grant from the Fetal Medicine Foundation. The authors declared having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.