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

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

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.

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

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.

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.