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
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