Including ethical considerations in models for first-trimester screening for pre-eclampsia

Pre-eclampsia is a complication of pregnancy that threatens the health of both mother and baby. It has recently been discovered that aspirin is an effective treatment of pre-eclampsia, but only if the mother starts taking aspirin before the 12th week of pregnancy. Presently, much research into the development of a method of screening for pre-eclampsia, similar to that currently used to detect Down's syndrome during pregnancy, is underway. Some studies have suggested combining the Down's syndrome and pre-eclampsia screening tests during the first trimester of pregnancy. There are good reasons for this as the time frame for testing is the same and some of the same components can be used in both tests. However, in this paper, we analyse the types of risk and benefits associated with both tests and we find that the type of information required for patients to give consent, and the type of consent required (written, verbal or implicit), are not the same. We find it problematic to combine these tests, and we recommend performing each test independently of the other.