This past June, the Society for Maternal-Fetal Medicine (SMFM) published in theAmerican Journal of Obstetrics and Gynecologya special statement on a collection of two new checklists they created to support health care providers in identifying pregnant women at heightened risk of developing preeclampsia, a major cause of maternal and perinatal morbidity and mortality.
The two checklists, structured for the provider and the patient in mind, respectively, will help providers in recommending prophylactic low-dose aspirin to pregnant women who score as moderate-to-high risk for preeclampsia. Prophylactic low-dose aspirin can reduce the risk of developing preeclampsia in women at increased risk by up to 25%.
The checklists incorporate the United States Preventive Services Task Force’s six high-risk and nine moderate-risk factors for preeclampsia into a simple, uncluttered, single-page checklist, making it easy for the user to fill it out. However, it is left to the practice or provider to decide what qualifications, based on the checklist, qualify for low-dose aspirin recommendation, as well as the timeline of initiation and specific dosage. SMFM endorses that low-dose aspirin be recommended to patients with any high-risk factor(s) and considered for those with multiple moderate-risk factors. Additionally, they endorse the initiation of 81 mg daily aspirin at 12 to 28 weeks of gestation (preferably before 16 weeks) for those recommended low-dose aspirin.
The checklists are a solution to the current difficulties faced by providers in determining the risk of preeclampsia in pregnant women. The long list of risk factors make it difficult for providers to remember them all. If risk factors are spread out across a patient’s medical record, providers may miss them, meaning that women at heightened risk of developing preeclampsia go undetected and miss out on prophylactic low-dose aspirin treatment. The checklists circumvent these issues by bringing together all the risk factors onto a single page, that when used routinely in the health care setting should facilitate the thorough assessment and detection of heightened risk for preeclampsia and the recommendation of prophylactic low-dose aspirin when indicated.
By Mikaela Carrillo
(1) Combs CA, Montgomery DM, SMFM Special Statement: Checklists for Preeclampsia Risk-Factor Screening to Guide Recommendations for Prophylactic Low-Dose AspirinAmerican Journal of Obstetrics and Gynecology (2020), doi:https://doi.org/10.1016/j.ajog.2020.06.003.
Identification of anemia in pregnant women is important, since it is an important cause of multiple complications during pregnancy (preterm delivery, low birth weight and perinatal death), so it is recommended to all pregnant women, in the first prenatal visit and at 28 weeks of gestation, the measurement of serum concentrations of hemoglobin and hematocrit as a screening test for anemia.
Prenatal assessment seeks to identify, through clinical history, sociodemographic characteristics, mean blood pressure, Doppler of the uterine arteries and biochemical markers such as pregnancy-associated plasma protein A (PAPP-A) and placental growth factor (PlGF), those women who are at high risk of developing preeclampsia in order to take appropriate measures. that can help reduce that risk.