Ethnicity and preeclampsia: an equity approach to risk-prediction

Research Question Can ethnicity-specific risk prediction models improve the accuracy of preeclampsia risk assessment to improve perinatal outcomes and reduce disparities in maternity care for global majority women and birthing people (WABP) in the UK? Background Preeclampsia is a severe pregnancy complication associated with significant maternal and perinatal morbidity and mortality. WABP from global majority backgrounds, particularly Black and South Asian populations, face a disproportionate burden of preeclampsia and its adverse outcomes. Current prediction tools, either do not use ethnicity at all (National Institute for Health and Care Excellence) or use it as an individual predictor within a model (Fetal Medicine Foundation). Ethnicity-specific prediction models have been successful in heart failure which may indicate potential to reduce inequalities in prediction accuracy in preeclampsia. Aim The aim is to improve maternity care equity by developing ethnicity-specific models for predicting preeclampsia and supporting their implementation through co-designed educational resources for healthcare professionals. Objectives Explore ethnicity-specific risk factors for preeclampsia across various ethnic groups. Develop and validate tailored predictive models for global majority WABP. Co-produce educational resources to support clinicians in having culturally sensitive risk discussions with patients. Methods This research comprises three work packages (WPs): WP1: Retrospective analysis of Tommy's Clinical Decision Tool dataset using logistic regression to identify ethnicity-specific risk factors for preeclampsia. This includes stratified analyses by general (e.g., Black, Asian) and specific (e.g., Black African, Black Caribbean) ethnic subgroups. WP2: Development and validation of risk prediction models using multivariable logistic regression and machine learning approaches. These models will undergo internal and external validation in datasets from comparable populations. WP3: Co-production of educational resources for healthcare professionals WABP from global majority backgrounds and other key collaborators. Focus groups will be used to explore communication barriers and develop a training package to improve clinician competence in discussing ethnicity-related risks. Delivery Timelines The project will be completed over three years. Year 1: Data collection, cleaning, and analysis for WP1. Patient and public involvement (PPI) advisory and co-production groups established. Year 2: Development and internal validation of predictive models (WP2). Focus groups and co-design workshops. Year 3: External validation of models, piloting of educational resources. Dissemination of findings through publications, presentations, and knowledge mobilisation event. Patient Engagement and Involvement PPI has been integral to the project's design and will continue throughout its delivery. Engagement with WABP from global majority backgrounds informed the proposed aims and methodology. PPI groups will support data interpretation, model development, and educational materials. Co-production methodologies will optimise research inclusion. Impact and Dissemination This research aims to reduce inequalities in preeclampsia outcomes by improving risk prediction accuracy for global majority WABP. The outputs (validated ethnicity-specific predictive models and co-produced training package) will be shared through academic journals, conferences, and a freely accessible project website. Public engagement materials (written/video) and media outreach will raise awareness of equity-focused research findings. Project outputs have the potential to inform systemic changes in healthcare, increase care equity and reduce maternal and perinatal morbidity and mortality for WABP from global majority populations.