Preeclampsia Prevention in Ontario – Can we do better?

The Risks of Preeclampsia in Pregnancy

• Preeclampsia is a common and dangerous complication of pregnancy that causes high blood pressure and excess protein in urine¹ . Preeclampsia can result in premature birth, fluid in the lungs, bleeding problems, liver or kidney damage, seizures, stroke and even death².
• The life expectancy of people who develop preterm preeclampsia is reduced by an average of 10 years³.
• Preeclampsia is one of the leading causes of maternal and perinatal morbidity and mortality⁴
  

Preeclampsia Prevalence

• Pre-eclampsia affects 2% to 8% of all pregnancies globally⁴.
  
• Based on BORN’s data collection, the prevalence of preeclampsia in Ontario is 3.9-4.4%⁵

Prediction and Prevention

• Multi-factor early-pregnancy screening for preeclampsia can identify most women and birthing individuals at risk, particularly of early-onset, severe disease⁶.
• Taking low-dose aspirin can prevent 80%-94% of early-onset, severe preeclampsia⁶.

Care-Gap in Canada

• Most pregnant people in Canada do not have access to preeclampsia screening and a large majority are not offered low-dose aspirin when indicated⁶.
• In Ontario there is no standardized way of assessing the risk of pre-eclampsia

Recommendations

• A 2022 Ontario Health Technology Assessment concluded that a new screening technique, developed by the Fetal Medicine Foundation (“the FMF algorithm), is more effective than standard care in reducing the risk of pre-eclampsia with delivery at less than 37 weeks' gestation.
• Consideration should be given to multifactorial early-pregnancy screening for preeclampsia, as well as a timely initiation of low-dose aspirin in people who are identified to be at risk⁶.

BORN-Prenatal Screening Ontario Response

• In spring 2023, Prenatal Screening Ontario (PSO) established an expert task force to explore implementation considerations should this screening be made available in Ontario.
• The task force identified important factors for guiding systematic screening efforts, including equitable implementation of screening at the provincial level. The group also analyzed options and alternatives (i.e. a modified FMF algorithm).
• As a result of the collaboration, PSO now has consolidated guidance from a wide range of experts in Ontario and Quebec.
• BORN and PSO, in conjunction with partners at the Ministry of Health, are assessing next steps and are committed to reducing the risk of preterm preeclampsia for pregnant Ontarians.