A team of fetal medicine specialists, led by Professor Basky Thilaganathan at St George’s, have successfully implemented the UK’s first pre-eclampsia screening programme resulting in the reduction of pre-eclampsia by almost 25% at St George’s as the rate elsewhere continues to increase.

They did so by introducing a test that is more accurate at identifying women who would most benefit from taking aspirin to prevent the development of pre-eclampsia.

Pre-eclampsia is a condition that affects some pregnant women usually from around 20 weeks. Symptoms include high blood pressure and protein being present in urine, but can also include fluid retention leading to swelling, severe headaches, vision problems and pain below the ribs.

Although many cases are mild, it can lead to serious complications – especially if it occurs earlier in pregnancy. Timely diagnosis, monitoring and scheduled birth can improve the outcome for both mother and baby. Prevention is only possible by prescribing in early pregnancy to women at high risk of subsequently developing pre-eclampsia.

This study, published by BJOG: An International Journal of Obstetrics and Gynaecology, measured the clinical effectiveness of the Fetal Medicine Foundation (FMF) pre-eclampsia screening programme in a large population of women receiving routine care in a public health setting using retrospective analysis.

The study compared 7720 women who were screened for pre-eclampsia according to the standard NICE risk-based guidance and 4841 by the new FMF algorithm which combines maternal risk factors in the first trimester with blood pressure, a pregnancy hormone and a Doppler scan measurement. Those at high risk of pre-eclampsia from the FMF algorithm were prescribed 150g of aspirin daily while low risk pregnancies had no aspirin.

The results of the study, which included all singleton pregnancies at St George’s between January 2017 and March 2019, showed a 23% reduction in the overall prevalence of pre-eclampsia in the cohort managed with the FMF screening programme. Over the course of the study, there was also an 80% reduction in women presenting with preterm pre-eclampsia – the more clinically severe form of the disorder.

Professor Basky Thilaganathan, Clinical Director of Fetal Medicine at St George’s and Clinical Director of Tommy’s National Centre for Maternity Improvement, said: “This screening programme is feasible in an NHS setting and has resulted in a significant reduction of the earliest and most severe form of pre-eclampsia. The continued use of the current maternal risk-factor based preeclampsia screening programme in routine healthcare settings must be re-evaluated”.

Marcus Green, Chief Executive of Action on Pre-Eclampsia (APEC) the leading preeclampsia charity, said: “We know that this is a really important step in women having the safest pregnancies and the team at St George’s and the FMF have done some interesting work which is another very positive step in the right direction. This is good news for women.”

Jane Brewin, Tommy’s Chief Executive, said: “Putting this exciting research into practice has the potential to completely transform maternity care, benefitting doctors and patients alike by finding out who’s really at risk and personally tailoring their care so that precious NHS resources can be focused on those most in need.

She added: “Previous trials have proven the benefits of these tests and treatments, and now the team at St George’s has applied that science with such encouraging results, there’s more than enough evidence to say that national guidelines on pre-eclampsia should be reconsidered so that healthcare professionals can be empowered to provide the best support in the easiest way.”

The research team included the Fetal Medicine Unit at St George’s University Hospitals NHS Foundation Trust, the Vascular Biology Research Centre at St George’s University of London, the department of Obstetrics and Gynaecology at Ashford and St Peter’s NHS Foundation Trust and Tommy’s National Centre for Maternity Improvement a collaboration between the Royal College of Obstetrics and Gynaecology and Royal College of Midwives”.

Notes to editors

Interviews available with:

Professor Baskaran Thilaganathan, Clinical Director of Fetal Medicine at St George’s and Clinical Director of Tommy’s National Centre for Maternity Improvement

Marcus Green, Chief Executive of Action on Pre-Eclampsia (APEC)

Contact: Pippa Harper, Media Manager at St George’s, via philippa.harper@stgeorges.nhs.uk