The Implementation of Preeclampsia Screening and Prevention (IMPRESS) Study

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.