A new special report published in the American Journal of Obstetrics and Gynecology (AJOG) provides a groundbreaking approach to preeclampsia, one of the most pressing issues in maternal health today, and will translate the prediction of risk into prevention of disease.
The report, "Care plan for individuals at risk for preeclampsia: Shared approach to education, strategies for prevention, surveillance and follow up," provides specific recommendations for both expecting parents and clinicians. The Care Plan's recommendations include consideration of daily low-dose aspirin, surveillance, behavioral strategies, patient and provider education, addressing social determinants of health, and long-term follow-up. These recommendations are a significant shift from the current care approach, which has historically lacked a comprehensive, integrated strategy. While technology to reliably predict preeclampsia is imminent, until now there has not been clear direction on optimal strategies for its prevention.
A leading cause of pregnancy-related deaths in the U.S., preeclampsia is a disorder of high blood pressure that can result in preterm birth, organ damage, and other severe complications during pregnancy. The impact of preeclampsia can extend across a lifetime for both moms and babies. With maternal mortality rising in recent years and high blood pressure disorders in pregnancy (including preeclampsia) doubling since 2007, there is an urgent need to predict, prevent, and mitigate its devastating impact.
Fortunately, there are several effective interventions that have been associated with reduced risk of preeclampsia in individuals at increased risk. The new AJOG report synthesizes them all into an objective, evidence-based recommendation for the first time and provides checklists for both individuals at risk and health care providers, which can be downloaded and shared. Today, most pregnant individuals at increased risk do not receive even one of the interventions to prevent preeclampsia. For example, less than half of high-risk patients receive low-dose aspirin. By streamlining the evidence-based recommendations into a straightforward Care Plan, the report systematically outlines the multi-pronged preventive approach that patients at risk should be receiving, which includes:
Key recommendations for health care providers: Risk assessment including social determinants of health, pharmacological recommendations (including aspirin therapy and antihypertensive therapy), and behavioral recommendations (including specific information about diet, exercise, and sleep)
Key recommendations for persons at-risk for preeclampsia:
To discuss with a health care provider: Questions regarding aspirin use, exercise during pregnancy, blood pressure monitoring, and more
To do on their own: Watching for signs of preeclampsia with symptoms listed, checking blood pressure at home and reporting any readings greater than 140/90, implementing dietary, exercise, and sleep changes, and more
"This new comprehensive Care Plan, developed by a diverse group of preeclampsia experts, payers and advocates is a specific and clear set of recommendations based on peer-reviewed evidence and expert opinion," said James Roberts, M.D., a Maternal-Fetal Medicine researcher at the Magee-Womens Research Institute, UPMC and founding Principal Investigator of the Global Pregnancy Collaboration who is one of the lead authors. "The plan outlines medications, monitoring, behavioral modification, education, and considerations for social determinants of health. It is designed to be as safe, cost-effective, and practical to implement in real world practice as possible. The clear checklists further encourage their use for any pregnancy considered to be at increased risk for developing preeclampsia," added Dr. Roberts. He said the team intends to have these checklists translated into multiple languages to further improve access and use.
Objective prediction of preeclampsia risk months in advance will soon be possible, and the Care Plan answers the question of what to do with that information. An unprecedented collaboration between medical experts and preeclampsia advocates created this novel patient-centered Care Plan. It represents a critical step in preventing preeclampsia and saving lives."
Alison Cowan, M.D., M.S.C.R. and Head of Medical Affairs at Mirvie
Mirvie, a company developing the first platform to predict pregnancy complications by revealing the underlying biology, supported the independent development of this report to contribute to an increased understanding of how to prevent preeclampsia.
Eleni Tsigas, CEO of the Preeclampsia Foundation and one of the co-authors noted, "By centering preeclampsia survivors as experts and co-authors, alongside clinicians, researchers, and payers, we have produced a practical and proactive comprehensive Care Plan. It is written in clear and simple language, can be easily incorporated into electronic health record (EHR) systems, and is designed to be a cooperative plan for both women and their care teams. With consistent implementation in any setting, we expect this Care Plan will help address inequalities in maternal care."
With objective, predictive testing for preeclampsia imminently on the horizon, this integrated Care Plan will translate risk prediction into disease prevention. As many women without traditional risk factors will still develop preeclampsia, this combination of novel predictive and preventive tools will prove to be indispensable for all clinicians and patients seeking to prevent this serious pregnancy complication and the lifelong health impacts of preeclampsia.