- Page navigation anchor for RE: Screening for preeclampsia risk and prophylaxis with acetylsalicylic acidRE: Screening for preeclampsia risk and prophylaxis with acetylsalicylic acid
We commend Drs Jain, Bujold, Varner and Ray for their respective commentary and editorial on screening for and prevention of preterm preeclampsia (PE) with low dose acetylsalicylic acid (LDA), and the resulting opportunity this discussion provides to review the lack of cohesive, standardized early prenatal care for many Canadians.
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We have performed 3 implementation studies on first trimester PE screening based on the Fetal Medicine Foundation UK (FMF) algorithm in our local jurisdictions (Toronto, Calgary). PE screening was offered alongside first trimester aneuploidy screening programs with high risk patients advised to initiate LDA under the supervision of their healthcare provider (HCP). We observed high patient uptake and adherence to LDA, minimal operational impact and performance consistent with the published literature.(1, 2) The Calgary implementation study has since screened over 10,000 patients within the study protocol (REB19-0359) to further validate performance in a Canadian setting, with view to providing a clinical service.
While these studies confirm the feasibility of PE screening and prevention within an ultrasound facility-based program, they expose the challenges with broader implementation. As discussed, many jurisdictions lack sonographers trained in uterine artery doppler assessment and facilities for measuring placental growth factor. However, modified versions of the FMF algorithm excluding one or more components have been validated a...Competing Interests: Nan Okun received in kind funding for PlGF sample kits from Roche Canada for the implementation study referenced in 1. JoAnn Johnson received in kind funding for PlGF from RevvityReferences
- 1. Okun N, Hoffman B, Johnson J, et al. Implementation of multiple marker screening for preterm preeclampsia in a single tertiary obstetric centre. J Obstet Gynaecol Can. 2023:102220. Available at https://www.ncbi.nlm.nih.gov/pubmed/37726059.
- 2. Johnson JM, Walsh JD, Okun NB, et al. The implementation of preeclampsia screening and prevention (impress) study. Am J Obstet Gynecol MFM. 2023;5:100815. Available at https://www.ncbi.nlm.nih.gov/pubmed/36400421.
- 3. Tan MY, Wright D, Syngelaki A, et al. Comparison of diagnostic accuracy of early screening for pre-eclampsia by nice guidelines and a method combining maternal factors and biomarkers: Results of spree. Ultrasound Obstet Gynecol. 2018;51:743-50.
- 4. Carter J, Anumba D, Brigante L, et al. The tommy's clinical decision tool, a device for reducing the clinical impact of placental dysfunction and preterm birth: Protocol for a mixed-methods early implementation evaluation study. BMC Pregnancy Childbirt
- 5. Dobrow MJ, Hagens V, Chafe R, et al. Consolidated principles for screening based on a systematic review and consensus process. CMAJ. 2018;190:E422-E9. Available at https://www.ncbi.nlm.nih.gov/pubmed/29632037.
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