Intended for healthcare professionals


Predicting pre-eclampsia

BMJ 2015; 351 doi: (Published 25 November 2015) Cite this as: BMJ 2015;351:h6349
  1. Lucy C Chappell, NIHR research professor in obstetrics1,
  2. Jane Sandall, professor of social science and women’s health and NIHR senior investigator1,
  3. Ann Marie Barnard, chief executive2,
  4. Richard J McManus, NIHR professor of primary care research3
  1. 1Women’s Health Academic Centre, King’s College London, London SE1 7EH, UK
  2. 2Action on Pre-eclampsia, Evesham, Worcestershire WR11 4EU, UK
  3. 3Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
  1. Correspondence to: L C Chappell lucy.chappell{at}

A challenge that shouldn’t distract us from improving antenatal care across the board

A healthy mother and baby are the desired outcomes of all antenatal care, yet WHO estimates that every year around the world there are about 303 000 maternal deaths, 2.6 million stillbirths, and 2.7 million neonatal deaths. Pregnancy and birth are transformational life events, but optimal preparation for transition to motherhood often receives little attention.

Pregnancy in itself is not an illness or a disease, but comorbidities or evolving complications can lead to mortality or serious morbidity. Risk stratification of pregnant women has been proposed to enable increased surveillance and appropriate prophylactic interventions for those at greater risk of complications, while normalising healthy women who have a high likelihood of uncomplicated pregnancy. The linked study by Macdonald-Wallis and colleagues (doi:10.1136/bmj.h5948) reports the development and validation of a new prediction model for pre-eclampsia.3 They concluded that incorporating routinely collected blood pressure measurements into models based on early pregnancy maternal characteristics would improve risk stratification, “facilitating a reduction in scheduled antenatal care” for those at low risk of pre-eclampsia.

The current schedule for antenatal care …

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