Pre‐eclampsia risk‐stratified planned birth at term: A survey of women’s perspectives on acceptability and risk communication

INTRODUCTION: Pre-eclampsia (PE) remains a major complication of pregnancies, globally, and while there is no intervention proven to be effective in decreasing late preterm and term PE; the PREVENT-PE trial aimed to evaluate whether the intervention-a strategy of screening for PE risk at 35-36 weeks' gestation, and for a risk of ≥1-in-50, offering risk-stratified, planned early term birth-could reduce the incidence of subsequent PE, compared with usual care. MATERIAL AND METHODS: We aimed to evaluate the acceptability of trial participation and risk communication for women participating in The PREVENT-PE trial [ISRCTN41632964] in the United Kingdom. From March to October 2024, trial participants were invited, antenatally and/or postnatally, to complete an online survey, and acceptability and risk communication measures were compared by trial arm. RESULTS: Of those accessing the survey, 257 out of 478 (48.2%) were antenatal (median 35.4 weeks' gestation), and 485 out of 1617 (30.0%) were postnatal (median 25.6 weeks postnatally) respondents who were eligible. Antenatally, and by trial arm: (i) most women felt: comfortable with the trial (>70%); participation required little/no effort (>75%; 77.9% [intervention] vs. 91.7% [control], p = 0.05); confident in participation (>75%); the trial was acceptable (≈90%); and PE risk screening was fair (>90%), could reduce chances of becoming seriously ill (>90%), and understood how that could be achieved (>90%); (ii) half disagreed that timed birth for PE would interfere with competing priorities, although 20-30% agreed; (iii) ≥80% of participants felt listened to, were able to ask questions and receive helpful answers, had their preferences considered, had clear on the situation being discussed, and were confident about their decision; and (iv) ≈50% were uncertain about what was going to happen. Postnatally, views were more neutral, without an increase in negativity. CONCLUSIONS: Findings indicate that women find third-trimester screening for PE and risk-stratified planned early term birth highly acceptable, understand those risks, and the potential to favorably impact their pregnancy outcome.