{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T14:00:24Z","timestamp":1788789624115,"version":"build-2803163510"},"reference-count":37,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T00:00:00Z","timestamp":1751414400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Pre\u2010eclampsia causes adverse maternal and perinatal complications and is preventable through early screening and aspirin treatment. This study evaluates the predictive performance of the Fetal Medicine Foundation first\u2010trimester preterm pre\u2010eclampsia competing risks model in an Australian population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and Methods<\/jats:title><jats:p>This was a retrospective cohort study of prospectively collected multisite screening data and pregnancy outcomes between 2014 and 2017 in Australia. Individualized risk for preterm pre\u2010eclampsia was calculated using the Fetal Medicine Foundation model at 11\u201314\u2009weeks by using maternal factors, biophysical biomarkers (mean arterial pressure (MAP), uterine artery pulsatility index (UtA\u2010PI)), and serum biochemical biomarkers (placental growth factor (PlGF) and\/or pregnancy\u2010associated plasma protein A (PAPP\u2010A)). The predictive performance was evaluated using the area under the receiver\u2010operating characteristic curve (AUC) and calibration. The detection rates for delivery with preterm pre\u2010eclampsia were calculated at a 10% fixed false\u2010positive rate. Decision curve analysis of the model was evaluated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 29\u2009609 women screened, 132 (0.45%) experienced preterm pre\u2010eclampsia. The median age (interquartile range) was 34 (30\u201338) years. Women with pre\u2010eclampsia had higher multiple of the median values of MAP and UtA\u2010PI and lower values of PIGF and PAPP\u2010A compared to those without pre\u2010eclampsia. Combined screening by maternal factors, biophysical, and biochemical biomarkers yielded an AUC of 0.87 (95% CI 0.79\u20130.92), detecting 71% of preterm pre\u2010eclampsia cases at 10% fixed false\u2010positive rate, with the addition of PlGF improving the detection rate by 31% over sole PAPP\u2010A use. Preterm pre\u2010eclampsia screening using maternal factors with all biomarkers showed better clinical net benefit at preference thresholds between 1% and 12% compared to default strategies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The Fetal Medicine Foundation model, combining maternal factors with biophysical and biochemical biomarkers, demonstrated similar predictive performance in the Australian population compared to previous validation studies in other settings, detecting 71% of preterm pre\u2010eclampsia cases at 10% fixed false\u2010positive rate. The clinical utility analysis showed that early screening and intervention strategies based on a risk\u2010based screening approach is more beneficial than universal or no intervention strategies.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.70002","type":"journal-article","created":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T08:38:51Z","timestamp":1751445531000},"page":"1774-1782","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["External validation of the Fetal Medicine Foundation model for preterm pre\u2010eclampsia prediction at 11\u201314\u2009weeks in an Australian population"],"prefix":"10.1111","volume":"104","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5867-5105","authenticated-orcid":false,"given":"Sofonyas Abebaw","family":"Tiruneh","sequence":"first","affiliation":[{"name":"Monash Centre for Health Research and Implementation Faculty of Medicine, Nursing and Health Sciences, Monash University  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2263-3592","authenticated-orcid":false,"given":"Daniel Lorber","family":"Rolnik","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Monash University  Clayton Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roshan","family":"Selvaratnam","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Monash University, Monash Health  Clayton Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabricio","family":"da Silva Costa","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Monash University, Monash Health  Clayton Victoria Australia"},{"name":"Maternal Fetal Medicine Unit Gold Coast University Hospital and School of Medicine and Dentistry, Griffith University  Gold Coast Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"McLennan","sequence":"additional","affiliation":[{"name":"Sydney Ultrasound for Women  Sydney New South Wales Australia"},{"name":"Discipline of Obstetrics, Gynaecology and Neonatology The University of Sydney  Camperdown New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8019-1289","authenticated-orcid":false,"given":"Jon","family":"Hyett","sequence":"additional","affiliation":[{"name":"Ingham Institute for Applied Medical Research, Liverpool Hospital, Western Sydney University  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7609-577X","authenticated-orcid":false,"given":"Helena","family":"Teede","sequence":"additional","affiliation":[{"name":"Monash Centre for Health Research and Implementation Faculty of Medicine, Nursing and Health Sciences, Monash University  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4480-5690","authenticated-orcid":false,"given":"Joanne","family":"Enticott","sequence":"additional","affiliation":[{"name":"Monash Centre for Health Research and Implementation Faculty of Medicine, Nursing and Health Sciences, Monash University  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,7,2]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.12802"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41572-023-00417-6"},{"key":"e_1_2_13_4_1","volume-title":"Preeclampsia. 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