Background: Pre-eclampsia is a hypertensive disorder of pregnancy which, left untreated, can cause significant foeto-maternal morbidity. Accordingly, the National Institution for Health and Care Excellence (NICE) recommends that high-risk women be prescribed daily prophylaxis with 75-150mg aspirin from twelve weeks’ gestation until delivery. NICE stratifies risk using eleven maternal risk factors; however, no secondary research has been published evaluating the diagnostic accuracy of this algorithm. Objectives: Quantify the sensitivity and specificity of the NICE risk‑stratification algorithm in predicting pre‑eclampsia in pregnant women ≥16 years. Search Strategy: PubMed, Cochrane Library and SCOPUS. PROSPERO Registration: CRD42023437261. Selection Criteria: Papers with a CBEM Level of Evidence ≤4, published 2010‑2023. Data Collection and Analysis: 20 eligible studies consisting of 892,061 pregnancies were analysed. Logit-transformed sensitivities and specificities were modelled as bivariate distributions with random effects. Main Results: Maximum likelihood estimates for the NICE algorithm’s sensitivity and specificity were 44.7% (95% CI 32.3 – 57.8) and 88.0% (95% CI 87.4-88.7), respectively. There was significant heterogeneity between the studies in this analysis (χ ²(17) = 85.05 (p<.0001), I ²=99.8%) and, consequently, a low degree of certainty in these estimates. Conclusions: The NICE risk‑stratification algorithm performs remarkably poorly when used to predict pre‑eclampsia in any of three gestational categories. Clinicians should advise women that around 1 in 5 high-risk patients and 1 in 25 low-risk patients go on to develop pre‑eclampsia. However, future studies will likely alter these values and the confidence therein. Funding: None Key Words: Pre-eclampsia, High-risk Pregnancy, Sensitivity and Specificity, Predictive Value of Tests, Clinical Decision Rules.