Adverse foetal outcomes in patients with increased risk of preterm preeclampsia in the first trimester of pregnancy: a prospective study

Objective. To assess the rate for placenta-mediated adverse pregnancy outcomes (preeclampsia, preterm birth PTB, small for gestational age SGA) in women at high risk of preterm preeclampsia in the first trimester and to evaluate a possible association between placental dysfunction and foetal abnor­malities.
Materials and Patients. Pregnant patients were offered first trimester screening for preterm preeclampsia based on the Fe­tal Medicine Foundation algorithm; with a risk score ≥ 1:150 were recommended to use aspirin (150 mg/day) from screen­ing until 36 weeks.
Between November 2022-October 2023, 975 patients were en­rolled. 162 patients (16%) screened positive for preeclampsia. From this cohort, we analysed 400 pregnancy outcome re­cords: 76 at high risk (HR) for preeclampsia, 324 at low risk (LR).
Results. HR women showed higher rate of preterm pre­eclampsia (2.63%) compared to LR women (0.3%). The rates of gestational hypertension (11%) and SGA (14.5%) were also higher in the HR group (respectively 2.5% and 9.2% in the LR group). The HR group showed a higher rate of early and late PTB (1.3% and 11% vs 0.9% and 3.1% in LR group). Congenital anomalies in euploid foetuses were more frequent in HR pa­tients (7.9%) compared to LR ones (4.6%).
Women identified at HR of preterm preeclampsia are also at increased risk of other placenta-mediated adverse pregnancy outcomes (PTB, SGA); they may benefit from a higher surveil­lance care pathway.
Conclusions. The risk of foetal structural anomalies is greater in HR women: we recommend a careful foetal anatomical ul­trasound evaluation in the first and second trimester to early identify foetal structural anomalies.