Int J Gynecol Obstet 2019; 144: 325–329 wileyonlinelibrary.com/journal/ijgo | 325 © 2019 Internatonal Federaton of Gynecology and Obstetrics DOI: 10.1002/ijgo.12741 FIGO COMMITTEE REPORT Good clinical practce advice: First trimester screening and preventon of pre-eclampsia in singleton pregnancy  FIGO Working Group on Good Clinical Practce in Maternal–Fetal Medicine* ,a *Correspondence: Gian Carlo Di Renzo, Department of Obstetrics and Gynecology, University of Perugia, Santa Maria della Misericordia University Hospital, Perugia, Italy. Email: giancarlo.direnzo@unipg.it  Endorsed in March 2017 and April 2018 by the FIGO Executve Board. This advice should not be considered as standards of care or legal standards in clinical practce. a Working Group members and expert contributors are listed at the end of the paper. PREMISE Pre-eclampsia is a major cause of maternal and perinatal morbid- ity and mortality. Globally, this conditon is associated with 80 000 maternal and more than 500 000 infant deaths annually. 1 Evidence suggests that pre-eclampsia can be further subdivided into pre- term pre-eclampsia, with delivery before 37 weeks’ gestaton, and term pre-eclampsia, with delivery at 37 weeks or later. 2 Preterm pre-eclampsia is associated with a higher incidence of fetal growth restricton and both short-term and long-term maternal and peri- natal mortality and morbidity. 3,4 Obstetricians managing cases of preterm pre-eclampsia are faced with the challenge of balancing the need for achievement of fetal maturaton with the risks to mother and fetus from contnuing pregnancy. For the mother, short-term risks include progression to placental abrupton, HELLP syndrome (a group of signs in pregnant women including hemolysis, elevated liver enzymes, and low platelet count), eclampsia, cerebrovascular acci- dent, and death. 3 Additonally, the conditon is associated with an increased risk of death from future cardiovascular disease, hyperten- sion, stroke, and diabetes, and the life expectancy of women afected by preterm pre-eclampsia is reduced on average by 10 years. 5 For the fetus, preterm delivery is, in itself, associated with higher mor- tality rates and increased morbidity resultng from thrombocytope- nia, bronchopulmonary dysplasia, cerebral palsy, and an increased risk of various chronic diseases in adulthood. 6 There are major cost implicatons for management of women with pre-eclampsia and their babies, especially when the conditon is severe and associated with fetal growth restricton. 7,8 SCREENING Professional bodies currently recommend the prophylactc use of low- dose aspirin (60–80 mg/d) in women considered to be at high-risk of pre-eclampsia (Box 1). In the UK, the Natonal Insttute for Health and Care Excellence (NICE) recommends selecton of the high-risk group on the basis of ten factors from maternal characteristcs, medical his- tory, and obstetric history. 9 However, the performance of such screen- ing is poor, with detecton of about 40% of preterm pre-eclampsia cases and 33% of term pre-eclampsia cases at a screen-positve rate of 11%. 10 In the USA, the American College of Obstetricians and Gynaecologists (ACOG) recommends use of aspirin for women with a history of pre-eclampsia in more than one pregnancy or history of pre-eclampsia requiring delivery before 34 weeks of gestaton 11 ; however, this subgroup consttutes about 0.3% of all pregnancies and Box 1 Risk factors for pre-eclampsia. High (one risk factor or more) • History of pre-eclampsia • Chronic hypertension • Type 1 or 2 diabetes • Renal disease • Autoimmune disease • Multfetal gestaton Moderate (two or more risk factors) • Nulliparity • Obesity (body mass index >30 kg/m 2 ) • Family history of pre-eclampsia • Age >35 years • Personal history (low birth weight >10-year pregnancy interval, previous adverse outcome) • In-vitro fertlizaton