Improving PE/E Care Across the Continuum

Session: Clinical Interventions for Maternal Health: From Policy to Practice

Presenter: Peter Von Dadelszen, University of British Columbia
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Background: Pre-eclampsia remains a leading cause of maternal and perinatal morbidity and mortality. Of the 5-600,000 maternal and perinatal lives lost to pre-eclampsia annually, more than 99% are lost in less-developed countries. The PRE-eclampsia-eclampsia Monitoring, Prevention & Treatment (PRE-EMPT) initiative is endeavoring to reduce that unacceptable burden of loss.

Methodology: We are using discovery science and clinical research, meta-analysis, randomised controlled trials (individual and cluster), health services research and knowledge translation methods, strengthened by advocacy and community engagement, to address the burden of death and damage related to pre-eclampsia, and pregnancy hypertension more generally, in Africa, South America, South Asia, and Oceania.

Results: To date (5 of 7 years completed), we have determined: (i) the impact of low-dose calcium replacement to prevent pre-eclampsia in the existing literature; (ii) the effect of low-dose calcium replacement on the blood pressure of non-pregnant, calcium-deficient women; (iii) the ability to provide precise risk estimates to women with pregnancy hypertension, and the role of pulse oximetry in improving precision; (iv) the socio-cultural contexts of women, their communities and their caregivers as they relate to pregnancy complications, especially pre-eclampsia; (v) the ability of mobile health-supported community care providers to direct hypertensive women to receive hospital-based care; (vi) the feasibility of oral methyldopa, labetalol and nifedipine use to treat severe pregnancy hypertension; (vii) the best evidence for pre-eclampsia prevention and treatment; and (viii) gaps in advocacy tools.

Conclusions: Through a co-ordinated and cross-methodological approach, we are beginning to observe improvements in health outcomes for women at risk of, and with, pre-eclampsia. New knowledge is particularly directed towards providing mHealth-supported precision medicine to women wherever they reside. This approach should be generalizable to other complications of pregnancy and for newborns.