Role of the Gestosis Score in Prediction of Preterm Preeclampsia in Indian Cohort

Background Pre-eclampsia (PE) remains a significant cause of maternal and perinatal morbidity and mortality, affecting 13% of pregnancies globally and up to 19.3% in India, with notable regional variation. Preterm PE is associated with increased maternal morbidity, fetal growth restriction, iatrogenic preterm delivery, and long-term maternal cardiovascular risk. The Hypertensive Disorders of Pregnancy (HDP) Gestosis Score is a simple, cost-effective clinical tool that evaluates 27 risk factors to identify women at increased risk of PE, classifying risk as mild, moderate, or high. A score ≥ 3 indicates “At Risk.” The Revvity first-trimester quadruple screening test combines maternal characteristics, obstetric and family history, mean arterial pressure (MAP), and biochemical markers (PlGF, PAPP-A, β-hCG, AFP) to predict early- and preterm-onset PE with high detection rates. No study has directly compared the Gestosis Score with multiparametric biochemical screening in the Indian population. Methods In this prospective cohort study, 593 singleton pregnant women (11 + 0 to 13 + 6 weeks gestation) attending VMMC & Safdarjung Hospital were assessed using both the HDP Gestosis Score and the Revvity first-trimester quadruple test. Women with chromosomal or structural fetal abnormalities were excluded. Risk categorization and predictive performance were analyzed using odds ratios, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy. Statistical analysis was performed with IBM SPSS version 25. Results Among 593 women, the Revvity test identified 31 (5.2%) and 139 (23.4%) as high risk for PE < 32 and < 37 weeks, respectively, while the Gestosis Score identified 28 (4.7%) and 108 (18.2%) women in the same categories. Odds ratios were 1.21 (95% CI: 0.55–2.65; p = 0.63) for PE < 32 weeks and 1.18 (95% CI: 0.82–1.69; p = 0.36) for PE < 37 weeks. Diagnostic accuracy for PE < 32 weeks was 95.1% for the Revvity test and 90.3% for the Gestosis Score; for PE < 37 weeks, both tools achieved ~ 74.2% accuracy. The Gestosis Score showed high specificity and NPV, comparable to the Revvity test. Conclusion The HDP Gestosis Score demonstrates comparable predictive performance to the Revvity first-trimester quadruple test for preterm PE in this Indian cohort. Its simplicity, low cost, and feasibility make it a practical alternative for early risk assessment in resource-limited settings, while multiparametric screening remains advantageous where laboratory infrastructure is available. Integration of the Gestosis Score into routine antenatal care can facilitate timely identification and management of women at risk for preterm PE, potentially reducing maternal and neonatal complications.