Pre-eclampsia: Universal Screening or Universal Prevention for Low and Middle-Income Settings?

Abstract

Pre-eclampsia (PE) is a severe disorder that affects up to 8% of all pregnancies and represents an important cause of maternal and perinatal morbidity and mortality. The screening of the disease is a subject of studies, but the complexity and uncertainties regarding its etiology make this objective a difficult task. In addition, the costs related to screening protocols, the heterogeneity of the most affected populations and the lack of highly effective prevention methods reduce the potential of current available algorithms for screening. Thus, the National Specialized Commission of Hypertension in Pregnancy of the Brazilian Association of Gynecology and Obstetrics Federation (Febrasgo, in the Portuguese acronym) (NSC Hypertension in Pregnancy of the Febrasgo) considers that there are no screening algorithms to be implemented in the country to date and advocates that Aspirin and calcium should be widely used.

Prevention of pre‐eclampsia with aspirin: A systematic review of guidelines and evaluation of the quality of recommendation evidence

“…Before resolving discrepancies, the reviewers had an agreement of 98% for the inclusion of full texts. A total of 48 statements met the final inclusion criteria 25–72 : 34 (71%) were CPGs developed by a panel following a systematic search to inform practitioners and patients 25–56,69,71 and 14 (29%) were position papers, consensus statements, or lacked detailed methodology (Table 1), which prevented them from being considered a CPG (Table S1). 57–68,70,72 …”

Reviewing Accuracy of First Trimester Screening for Preeclampsia Using Maternal Factors and Biomarkers

“…77 The National Specialized Commission of Hypertension in Pregnancy of the Brazilian Association of Gynecology and Obstetrics Federation recently published their statement on preeclampsia screening, stating that given the cost and logistics required to implement universal multiparametric screening in a country with few resources, universal prophylaxis with low dose aspirin would be preferable, particularly in view of the other benefits such as reduced preterm birth and perinatal mortality as demonstrated in the ASPIRIN trial. 76,78 This is echoed even in a HIC, with the ACOG practice advisory recently stating that in some areas, there may be such a proportion of high risk groups that an institution may decide to adopt a policy of universal aspirin prophylaxis for their population. 79…”