Introduction: Recent evidence suggests that the risk of preterm preeclampsia can be substantially reduced by the prophylactic use of low dose aspirin (ASA). The indications for the use of ASA in pregnancy are however, the subject of much debate. The purpose of this study was to evaluate current practice and attitudes among Canadian obstetric care providers (Obstetricians/Gynecologists (OB/GYN), Maternal Fetal Medicine (MFM) specialists, Family physicians (FP) and Midwives (MW)) on screening for preeclampsia and the use of low dose aspirin (ASA) for the prevention of preeclampsia.
Methods: A survey was distributed online through the Society of Obstetricians & Gynecologists of Canada (SOGC). Chi-squared tests were used to detect differences in knowledge and attitudes between groups.
Results: 336 respondents completed the survey: 55.1% OB/GYN,17.0% FP, 14.6%, MFM, 10.0% MW. Guidelines followed: SOGC 57.2%, ACOG 17%, NICE 7.5%, local guidelines 18.2%. Percentage of respondents who prescribe ASA for prevention of preeclampsia; 96.7%, prior to 16 weeks’ gestation: 96.6%, recommended dose162 mg OD: 38% (MFMs 61.2%, OB/GYN 48.6%, FP 45.6%, and MW 38.2%), recommended time of day to take ASA: bedtime 56.5%, recommended gestational age to stop ASA: 36 weeks gestation MFMs (87.8%), OB/GYNs (71.9%), MWs (67.6%) and FPs (59.6%, p=0.014).
Conclusion: This study provides important information regarding the current practice among obstetric care providers in Canada with regard to preeclampsia screening and prevention. While most recommend ASA for the prevention of preeclampsia, the screening guidelines followed, ASA dosage and dosage schedules recommended, and timing of stopping of ASA were variable. This baseline knowledge will enable the focused development of educational materials for implementation of PE screening and prevention based on recent high-grade evidence regarding predictive screening algorithms and optimal use of ASA for prevention.
Amy Metcalfe– Associate Professor, Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB
Jo-Ann Johnson– Maternal-Fetal Medicine specialist, University of Calgary
Emmanuel Bujold– Physician and clinical researcher, Department of Obstetrics & Gynaecology, Faculty of Medicine, Universite ́ Lava