Improving Clinical Outcomes Related to Preeclampsia: Real-World Impacts of Implementation of a Redesigned Approach to Antenatal Care-The Initial Maternity Assessment and Planning (IMAP) Service.

introductionPreeclampsia is a major contributor to maternal and perinatal morbidity. First-trimester predictive models for preterm preeclampsia have better efficacy than history-based screening for prevention of this adverse pregnancy outcome. There are, however, few data describing implementation of this method of screening at a population level within public healthcare. MATERIALS AND

methodsA retrospective service evaluation compared a historical cohort receiving standard maternity care and a contemporary cohort managed through the Initial Maternity Assessment and Planning (IMAP) service, a redesigned antenatal care approach focused on early multidisciplinary specialist maternity assessment and algorithm-based preeclampsia screening prior to 14 weeks gestation. Singleton pregnancies within a metropolitan public hospital catchment were included. The primary outcome was preterm preeclampsia (leading to birth < 37 weeks). Secondary clinical outcomes included early-onset preeclampsia (leading to birth < 32 weeks), severe maternal preterm preeclampsia, and rates of potential aspirin-related obstetric complications. Secondary service outcomes included gestation at first visit and rates of early aspirin therapy for women at elevated risk.

resultsHistorical and contemporary cohorts included 5 004 and 6 036 pregnancies, respectively. Median gestation at first visit decreased from 20 to 12 weeks. Analysis demonstrated a 49% reduction in the odds of preterm preeclampsia (0.91% to 0.60%; aOR 0.51, 95% CI 0.31-0.82) and a 59% reduction in the odds of severe preterm preeclampsia (0.38% to 0.20%; aOR 0.43, 95% CI 0.19-0.91). No significant differences were observed in early-onset or term preeclampsia, fetal growth restriction, or complications related to antiplatelet therapy. The screen positive rate fell from 9.0% to 7.2%, while aspirin recommendation for high-risk women increased from 23.9% to 77.8% overall and 98.2% in those receiving FMF screening.

conclusionA comprehensive, population-based multidisciplinary first-trimester assessment service, prioritizing FMF preeclampsia screening, can be successfully implemented within a public health setting and may be associated with lower odds of adverse clinical outcomes.