A bold, unsettling truth about late-term pregnancy care: a carefully tailored screening at 36 weeks can significantly cut the risk of pre-eclampsia at term, without adding danger to either mother or baby. And this is where it gets interesting: a modern strategy combines late-pregnancy risk assessment with personalized timing of birth to prevent term pre-eclampsia safely. This approach could transform how care is delivered to women at the highest risk.
A major study published in The Lancet explored whether screening for pre-eclampsia at 36 weeks, followed by risk-based planning for delivery between 37 and 40 weeks, could meaningfully reduce term pre-eclampsia in singleton pregnancies managed within UK maternity services.
The burden and challenge of term pre-eclampsia
Pre-eclampsia remains a leading hypertensive complication in pregnancy, capable of causing severe illness and even death for both mother and baby. It affects about 3% of pregnancies, with roughly three-quarters of cases occurring at term (37 weeks or later) and contributing to a sizable share of maternal and perinatal harm.
To tackle this, the FMF (Fetal Medicine Foundation) competing-risks model is used at 11–13 weeks to flag about 10% of screened women as high risk. This model correctly predicts around 75% of those who will develop preterm pre-eclampsia, outperforming models based only on clinical factors, which catch about 40%. Preventive aspirin can cut preterm pre-eclampsia by roughly 60%, but it doesn’t substantially reduce term pre-eclampsia.
Using the FMF model again at 35–36 weeks helps identify those at risk for late preterm and term pre-eclampsia, detecting about 70% of these cases. However, there are currently no highly effective preventive therapies for this group.
Previous research hinted that elective induction of labor at term could lower term pre-eclampsia rates. This idea found support in a Cochrane review and a trial involving low-risk first-time mothers randomly assigned to early-term birth, as well as large observational datasets on 36-week screening followed by planned early-term birth in at-risk women.
Design and eligibility of the PREVENT-PE trial
PREVENT-PE was an open-label randomized controlled trial conducted at two UK maternity hospitals. Eligible participants were women aged 16 or older with a single fetus and no major congenital abnormalities, and none had pre-eclampsia at baseline.
All participants were randomized before any risk stratification. At 36 weeks, the FMF competing-risks model was used to estimate each woman’s risk of term pre-eclampsia, incorporating:
- Maternal factors: age, body mass index, ethnicity, and mode of conception
- Medical history: prior hypertensive disorders, chronic hypertension or diabetes, prior or family history of pre-eclampsia, and autoimmune conditions like systemic lupus erythematosus
- Laboratory markers: placental growth factor and soluble fms-like tyrosine kinase-1
- Blood pressure: mean arterial pressure
Women in the intervention group identified as high-risk (defined as a 1 in 50 or greater chance of pre-eclampsia) were offered a risk-stratified plan for delivery between 37 and 40 weeks, with earlier scheduling for those at higher risk. About three-quarters of the intervention group were categorized as low risk and continued with standard care. The control group received standard care regardless of risk status.
Participant profile and screening results
The final analysis included 8,094 women with a mean age in the early thirties and a tendency toward higher BMI. The majority (approximately 74%) were White, around half were expecting their first child, about 3% had a prior pregnancy complicated by pre-eclampsia, and roughly 4% reported a family history of the condition.
The 36-week FMF model was chosen because it provides the most accurate predictions for term pre-eclampsia. A personalized birth plan was created in the intervention group based on each person’s calculated risk. About 7% of fetuses were small-for-gestational-age, and a similar proportion were large-for-gestational-age. Around 17% of participants used preventive aspirin.
Risk-stratified birth reduced term pre-eclampsia
In the intervention group, there were 158 cases of pre-eclampsia among 4,037 births (roughly 4%), versus 226 cases among 4,057 births in the control group (about 5.6%). This represents a 30% relative reduction in term pre-eclampsia when analyzed by intention-to-treat using the ISSHP 2021 criteria.
Safety outcomes were reassuring: there was no increase in serious adverse events in either group (rates under 0.3%), no rise in postpartum pre-eclampsia, no more emergency C-sections, and no uptick in neonatal intensive care unit admissions for babies of mothers in the intervention group.
Participation was robust, with around 75% of eligible women enrolling and few dropping out. This strong uptake implies that risk-driven, timed birth at term is acceptable to many patients. Further studies will assess the direct and indirect costs, plus qualitative insights from participating women and healthcare staff.
What this means for future practice
Delivering at early term to those identified as high-risk for pre-eclampsia, guided by a personalized risk assessment at 36 weeks, can lower the incidence of term pre-eclampsia without adding maternal or neonatal risk. This trial is the first randomized evaluation to demonstrate such a benefit using a personalized, risk-stratified approach within a routine care pathway that includes a 36-week ultrasound for birth planning.
If subsequent cost-effectiveness analyses and acceptability studies support these findings, guidelines could shift toward incorporating risk-based, timed birth strategies for women at heightened risk of term pre-eclampsia.
Journal reference:
Goadsby, J., Syngelaki, A., Magee, L. A., et al. (2025). Scheduled birth at term for the prevention of pre-eclampsia (PREVENT-PE): an open-label randomised controlled trial. The Lancet. DOI: 10.1016/S0140-6736(25)01207-3
