First-trimester screening for pre-eclampsia: moving from personalized risk prediction to prevention.

Maternal gestational hypertensive disorders and their complications have ranked consistently as the primary cause of adverse maternal and neonatal outcome since the institution of prenatal care1. The recognition of predisposing circumstances, such as nulliparity, familial disposition, prior pre-eclampsia, renal disease, hypertension and diabetes, reaches back as far as four centuries. In 1984, Leon Chesley concluded that: ‘it does not seem likely that pre-eclampsia can be prevented on the basis of current knowledge. A major purpose of prenatal care is to detect incipient pre-eclampsia and to prevent its progression’1. Since then, research that has evolved around first-trimester screening algorithms for pre-eclampsia has offered a significant opportunity to rethink the potential for preventive strategies.