Reducing health inequality in Black, Asian and other minority ethnic pregnant women: impact of first trimester combined screening for placental dysfunction on perinatal mortality

Abstract

Objective To assess the impact of the Fetal Medicine Foundation (FMF) first trimester screening algorithm for pre‐eclampsia on health disparities in perinatal death among minority ethnic groups. Design A retrospective cohort study from July 2016 to December 2020. Setting A large London teaching hospital. Patients and methods All women who underwent first trimester pre‐eclampsia risk assessment using either the NICE screening checklist or the FMF multimodal approach. Women considered at high‐risk in the FMF cohort were offered 150 mg aspirin before 16 weeks' gestation, serial growth scans and elective birth at 40 weeks. Main outcome measures Stillbirth, neonatal death and perinatal death rates stratified by screening method and maternal ethnicity. Results In the NICE cohort, the perinatal death rate was significantly higher in non‐white than white women (7.95 versus 2.63/1000 births, OR 3.035, 95% CI 1.551–5.941). Following the introduction of FMF screening, the perinatal death rate in non‐white women fell from 7.95 to 3.22/1000 births (OR 0.403, 95% CI 0.206–0.789), such that it was no longer significantly different from the perinatal mortality rate in white women (3.22 versus 2.55/1000 births, OR 1.261, 95% CI 0.641–2.483). Conclusions First trimester combined screening for placental dysfunction is associated with a significant reduction in perinatal death in minority ethnic women. Health disparities in perinatal death among ethnic minority women demand urgent attention from both clinicians and health policy makers. The data of this study suggest that this ethnic health inequality may be avoidable. Tweetable abstract Multimodal early pregnancy placental dysfunction screening can lead to a significant reduction in perinatal deaths in non‐white women.

Preventing Stillbirth: A Review of Screening and Prevention Strategies

“…19 The same authors evaluated the impact of these improvements in pregnancy outcomes on the prevalence of perinatal death (PND) rate-combining stillbirth after 24 weeks and neonatal death within 28 days of birth. 20 The perinatal death rate was reduced from 4.46/ 1000 to 2.78/1000 births with a screening program based on the NICE checklist vs. the FMF combined screening. Specifically, there was a 70% reduction in PND associated with PE and/or FGR resulting in a fall in PND rates from 1.73/1000 to 0.48/1000 births (Fig.…”

Placental dysfunction screening and perinatal loss

“…We thank these eminent academics for their interest in our work and for acknowledging the importance of stark ethnic health inequalities in maternity outcomes in the UK. 1 We welcome open and balanced academic discourse but were disappointed to see the term 'racial inequalities' in their communication to the Journal. Race is perceived as inherent in biology, inherited across generations and therefore potentially unmodifiable.…”

Re: Reducing health inequality in Black, Asian and other minority ethnic pregnant women: Impact of first‐trimester combined screening for placental dysfunction on perinatal mortality

“…This article addresses an important problem of racial inequalities in pregnancy outcomes. The authors conclude that the implementation of the Fetal Medicine Foundation (FMF) algorithm for pre-eclampsia, compared with screening using National Institute for Health and Care Excellence (NICE) criteria, is associated with a reduction in perinatal deaths in women of non-white ethnic origin, by 60%, 1 and equitable outcomes between the ethnic groups. We do not consider the findings support this conclusion, for the following reasons:…”

“…John Allotey 1 Susan Bewley Ash Paul 7 Maarten van Smeden 8 Shakila Thangaratinam 1,9 James G. Thornton 10…”