A 36-week screen and planned early birth cut term pre-eclampsia in a UK trial
There has been no reliable way to prevent pre-eclampsia at term. PREVENT-PE screened over 8,000 women late in pregnancy and offered earlier birth to those at highest risk — and pre-eclampsia fell by nearly a third.
| Group | Value (%) |
|---|---|
| Intervention | 3.9 |
| Usual care | 5.6 |
Most of the effort to prevent pre-eclampsia is aimed early in pregnancy — low-dose aspirin started in the first trimester for women screened as high risk. But a substantial share of pre-eclampsia appears at term, in the final weeks, where there has been no reliable way to head it off short of delivering the baby. PREVENT-PE, a UK randomised trial published in 2026, tested a simple idea: screen for pre-eclampsia risk at around 36 weeks, and offer planned early-term birth to the women at highest risk. The rate of pre-eclampsia fell by close to a third [s1].
What the trial did
PREVENT-PE was an open-label, randomised controlled trial run at two maternity hospitals in the UK [s1]. Women with a singleton pregnancy and a live fetus without major anomalies were approached when they came in for routine ultrasound between 35 weeks and 0 days and 36 weeks and 6 days [s1]. Those who consented were randomly assigned, one to one, either to the intervention — a pre-eclampsia risk assessment, with risk-stratified planned early-term birth offered to anyone whose estimated risk was 1 in 50 or higher — or to usual care at term [s1]. The primary outcome was birth complicated by pre-eclampsia, defined by International Society for the Study of Hypertension in Pregnancy criteria [s1].
The scale was large. Of 11,280 women presenting for the 36-week scan between May 2023 and June 2024, 10,803 (95.8%) were eligible, and 8,136 (75.3%) were randomly assigned [s1]. After a handful of withdrawals and enrolment errors, 8,094 women (99.5% of those randomised) were analysed: 4,037 in the intervention group and 4,057 in the control group [s1]. About a quarter — 2,098 of 8,094 (25.9%) — self-reported non-White ethnicity [s1].
What it found
Pre-eclampsia occurred in 158 of 4,037 births (3.9%) in the intervention group and 226 of 4,057 (5.6%) in the control group — an adjusted risk ratio of 0.70 (95% CI, 0.58 to 0.86) on intention-to-treat analysis with imputation [s1]. In plain terms, screening at 36 weeks and offering earlier birth to the highest-risk women cut the chance of developing pre-eclampsia by about 30%.
Crucially, that benefit did not come at an obvious cost. Serious adverse events were rare and did not differ between groups: five (0.1%) of 4,031 in the intervention group and ten (0.2%) of 4,048 in the control group (Fisher's exact test, P = 0.30) [s1]. The investigators report that the intervention did not increase emergency caesarean section or neonatal unit admission — the two harms one might expect from bringing births forward [s1].
Why this is a genuine step
Term pre-eclampsia has been a stubborn gap. Aspirin works mainly against early, preterm pre-eclampsia, and the disease that emerges near term has largely been managed by watching and reacting. PREVENT-PE flips that to a pre-emptive strategy, and the logic is sound: once a fetus is at early term, the risks of continuing a high-risk pregnancy can outweigh the modest risks of a planned birth a little sooner. That the trial saw a real reduction in pre-eclampsia without a spike in caesareans or neonatal admissions is what makes it more than a theoretical gain [s1]. Health Newspapers has covered the parallel debate over how high a dose of aspirin best prevents the earlier form of the disease.
How much to trust it
The strengths are the randomised design, the very large and well-retained sample, and a hard, clinically defined primary outcome [s1]. The limits are worth stating plainly. The trial was open-label — women and clinicians knew the allocation — which can influence how a diagnosis like pre-eclampsia is pursued and recorded. It ran at just two UK hospitals, so how well it transfers to other systems and populations is untested. And it was funded by the Fetal Medicine Foundation, a charity whose researchers have long championed risk-based screening in pregnancy; that is a non-commercial funder, but one with an intellectual stake in the approach [s1].
What it means for a reader
For now this is trial evidence, not routine care. If you are pregnant, it does not change what your maternity service offers today, but it points to where term care may be heading: a risk check late in pregnancy that could make planned early birth a shared, evidence-based choice for some women. This article is informational and is not medical advice.
What to watch
Whether guideline bodies and larger, multi-centre trials confirm the finding, and whether the screening tool used at 36 weeks performs as well outside the hospitals that developed it. A single open-label trial rarely changes practice on its own — but PREVENT-PE has made term pre-eclampsia look, for the first time, like something that can be anticipated rather than only managed [s1].
Sources
Sources
- Scheduled birth at term for the prevention of pre-eclampsia (PREVENT-PE): an open-label randomised controlled trial — The Lancet , December 4, 2025
What helps pregnancy heartburn safely? Diet, antacids and the evidence
Heartburn is one of the most common complaints in pregnancy. Diet and posture changes come first; a Cochrane review found antacid-type medicines relieve it, but the trial evidence is thin and drug choice needs care.
What helps morning sickness? Ginger, vitamin B6 and the evidence
Nausea in early pregnancy is common and usually mild. Ginger has the best trial support for nausea, vitamin B6 and doxylamine are options, and acupuncture shows no clear benefit.
Two perinatal behaviour trials missed their endpoints, then found something after
A postpartum smoking programme and a safe-sleep video series each failed the question they were designed to answer. What they reported next is where the interpretation gets difficult.
A first-trimester blood protein flags preeclampsia risk months early
Screening 2,904 proteins in early pregnancy, researchers found low maternal isthmin-2 was the strongest signal for later preeclampsia or fetal growth restriction, validated in two cohorts.