Bold claim: risk-led timing of birth at term can meaningfully cut the rate of pre-eclampsia without adding risk to mothers or babies. And this is the part most people miss: a 36-week risk assessment paired with individually timed delivery could reshape late-pregnancy care for those at highest risk.
A recent open-label randomized trial, PREVENT-PE, explored whether screening for term pre-eclampsia at 36 weeks, followed by risk-stratified planned birth between 37 and 40 weeks, could reduce term pre-eclampsia in singleton pregnancies managed in the UK. Pre-eclampsia remains a leading hypertensive complication in pregnancy, threatening both mother and child. Until now, no proven intervention reliably lowers term pre-eclampsia. This study sought to fill that gap by testing a targeted, personalized approach.
Understanding the burden and challenges of term pre-eclampsia
Pre-eclampsia affects about 3% of pregnancies and is a major driver of maternal and perinatal illness and death. Roughly three-quarters of term cases occur at 37 weeks or later and contribute to a large share of maternal deaths and substantial neonatal risk.
The FMF competing-risks model, used early in pregnancy, flags about 10% of women as high risk and correctly identifies roughly 75% of those who will develop preterm pre-eclampsia, outperforming clinical factors alone. Aspirin can substantially lower preterm pre-eclampsia risk in high-risk individuals, but it does little to prevent term cases. When the FMF model is applied again at 35–36 weeks, it can predict late preterm and term pre-eclampsia in about 70% of cases, though effective preventive options for this group are limited.
Building on prior work
Earlier research suggested that delivering at term electively might reduce term pre-eclampsia rates. This view is supported by a Cochrane review and randomized trials in low-risk first pregnancies, as well as large observational data linking 36-week screening with planned early-term birth in at-risk groups.
How PREVENT-PE was designed
The PREVENT-PE trial enrolled two UK maternity hospitals and randomised eligible participants to intervention or standard care before risk stratification. Eligible women were 16 years or older, carrying a singleton fetus without major anomalies, and free from pre-eclampsia at baseline.
At 36 weeks, all participants underwent the FMF competing-risks assessment, incorporating maternal factors (age, weight, ethnicity, conception method), obstetric history (hypertension, diabetes, prior pre-eclampsia, family history, autoimmune conditions), serum biomarkers (placental growth factor and soluble fms-like tyrosine kinase-1), and mean arterial pressure. High risk was defined as a calculated pre-eclampsia risk of 1 in 50 or greater.
In the intervention arm, those at high risk were offered risk-stratified planned birth between 37 and 40 weeks, with those at higher risk scheduled earlier. The majority of participants in this arm (about 78%) were classified as low risk and received usual care. The control group received standard care regardless of risk status.
Participants and outcomes
From 8,094 analyzed participants, the average age was in the early thirties, and most had a high body mass index. The majority (74%) identified as White, about half were first-time mothers, and a small subset had prior pregnancies affected by pre-eclampsia or a family history of the condition.
The 36-week FMF assessment informed individualized birth plans in the intervention group. About 7% of fetuses were small-for-gestational-age and a similar fraction large-for-gestational-age. Around 17% took aspirin preventively.
Impact on term pre-eclampsia and safety
In the intervention group, 158 of 4,037 births (4%) developed pre-eclampsia, compared with 226 of 4,057 births (5.6%) in the control group. This represents a 30% relative reduction in term pre-eclampsia when analyzed by intention to treat using established diagnostic criteria.
Crucially, there were no increases in serious adverse events in either group (rates below 0.3%), no rise in postpartum pre-eclampsia, no more emergency cesarean deliveries, and no greater need for neonatal intensive care unit admission among babies born to those in the intervention group.
Participation and next steps
About three-quarters of eligible women chose to participate, with few withdrawals or losses to follow-up. This suggests the risk-based, timed-birth approach at term is acceptable to many patients. The study also plans to assess direct and indirect costs and to gather qualitative insights from participating women and clinical staff.
Implications for practice
This study provides the first randomized evidence that a personalized, risk-stratified approach—guided by a 36-week screening and followed by a planned early-term birth for those at high risk—can reduce term pre-eclampsia without increasing maternal or neonatal risk. If future cost-effectiveness analyses and guideline reviews support these findings, risk-based term birth planning could become part of standard care for women at elevated risk of term pre-eclampsia.
Source 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
