Aim: The purpose of this study was to compare the accuracy of the National Institute for Health and Care Excellence (NICE) guidelines and the American College of Obstetricians and Gynecologists (ACOG) recommendations for pre-eclampsia (PE) screening. Methods: This retrospective study included 4600 Thai pregnant women who received maternity care between January 2006 and December 2015 at Songklanagarind Hospital, a tertiary care center in southern Thailand. The medical data of each participant were assessed using the NICE and ACOG criteria to identify maternal risk for PE. The sensitivity, specificity, positive likelihood ratio and negative likelihood ratio for detecting pregnancies complicated with PE according to each guideline were calculated. Receiver operating characteristic (ROC) curves were constructed to compare the predictive performance. Results: Pre-eclampsia was found in 167 cases (3.63%). The ACOG recommendations achieved ROC area 0.70 (58.1% sensitivity with 82.4% specificity) for PE at any gestation and ROC area 0.66 (62.9% sensitivity with 69.0% specificity) for PE which required delivery before 37 weeks' gestation. ROC areas based on the NICE guidelines were 0.64 (35.3% sensitivity with 92.5% specificity) and 0.59 (34.8% sensitivity with 83.4% specificity) for all PE and preterm PE, respectively. The ACOG criteria were significantly more accurate than the NICE criteria for detecting maternal risk for all PE, preterm PE and nulliparity cases (P values <0.05). Conclusion: For Thai pregnant women, screening for PE with maternal risk factors according to the ACOG recommendations was more effective in identifying high-risk pregnancies than the NICE guidelines.

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