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Related Experiment Video

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A Novel Method for Involving Women of Color at High Risk for Preterm Birth in Research Priority Setting
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The Implementation of Preeclampsia Screening and Prevention (IMPRESS) Study.

J M Johnson1, Jennifer D Walsh1, Nanette B Okun2

  • 1Departments of Obstetrics and Gynecology (Drs J Johnson and Walsh, Ms Pastuck, Dr Metcalfe, Mr Maxey, and Drs Soliman, Kuret, Dwinnell, Chada, O'Quinn, Schacher, and Somerset).

American Journal of Obstetrics & Gynecology MFM
|November 18, 2022
PubMed
Summary

This study demonstrates the feasibility of implementing preeclampsia screening and low-dose aspirin prevention in Canada. The evidence-based approach successfully identified high-risk pregnancies for timely intervention.

Keywords:
aspirinbiomarkersfirst trimestermean arterial blood pressureplacental growth factorpreterm preeclampsiapreventionscreeninguterine artery Doppler

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Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine
  • Public Health

Background:

  • Preeclampsia is a leading cause of maternal and infant mortality globally.
  • Current risk-factor-based screening for preeclampsia is less effective than algorithm-based screening with aspirin treatment.
  • Real-world implementation studies of this evidence-based approach are lacking in Canada.

Purpose of the Study:

  • To assess the operational feasibility of integrating first-trimester preeclampsia screening and prevention into existing Canadian public health programs.
  • To evaluate the implementation of screening for preterm preeclampsia alongside aneuploidy screening.
  • To determine the effectiveness of low-dose aspirin in preventing preterm preeclampsia.

Main Methods:

  • Prospective implementation study involving consecutive pregnant patients undergoing first-trimester screening.
  • Utilized the Fetal Medicine Foundation algorithm incorporating maternal risk factors, mean arterial pressure, uterine artery Doppler, PAPP-A, and PlGF.
  • Assessed implementation metrics: acceptability, operational impact, aspirin initiation rates, safety, and screening performance.

Main Results:

  • High patient uptake (98.3%) and successful integration into existing screening programs.
  • Screening and prevention program added minimal time to appointments (6-8 minutes).
  • 78.3% of high-risk patients were contacted, and 86.1% initiated aspirin; 71.4% of preterm preeclampsia cases were detected.

Conclusions:

  • Confirms the operational feasibility of implementing evidence-based preeclampsia screening and prevention in a Canadian public healthcare setting.
  • Supports the scaling up of this program regionally and provincially.
  • Facilitates the integration of effective preeclampsia screening and prevention into routine clinical practice.