FIGO First Trimester Preeclampsia Screening Guidelines: Prevention Using Clinical Information and Biomarkers
Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Discuss the FIGO recommendations for first trimester screening for preterm preeclampsia 2. Describe preventative treatments for those at high risk for preterm preeclampsia
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from 7/1/2019 through 1/25/2023, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
Designated for 0.1 contact hours of pharmacotherapy credit for Advance Practice Registered Nurses.
FIGO released first trimester preeclampsia screening
guidance that provides recommendations for assessing risk based not only on
clinical history and findings, but also biomarkers. FIGO calls for universal screening for
All pregnant women should be screened for preterm PE during early pregnancy by the first‐trimester combined test with maternal risk factors and biomarkers as a one‐step procedure
Combined Tests for Preeclampsia
Best Combined Test
(high risk defined as ≥ 1
Combination of clinical factors and biomarkers (see ASPRE summary in ‘Related ObG Topics’ below) including
Maternal risk factors
Mean arterial pressure (MAP)
serum placental growth factor (PlGF)
Uterine artery pulsatility index (UTPI)
is open access and available in the ‘Learn More – Primary Sources’ below
PlGF and/or UTPI Not Available
Use maternal risk factors and MAP
Do not use maternal risk factors alone
Screening performance will be reduced when screening does not include all elements of the combined test
Contingent Screening in Limited Resource Settings
Use maternal factors and MAP
Consider reflex to PlGF and UTPI for those at increased risk a subgroup of the population
FIGO Uses ISSHP Preeclampsia Definition
Systolic BP ≥140 mm Hg
and/or diastolic BP ≥90 mm Hg on at
least two occasions measured 4 hours apart in previously normotensive women,
with ≥1 of the following new‐onset
conditions ≥20 weeks
Sitting position with arms at heart level, using appropriately sized cuff (after 5 minute rest)
Mid‐arm circumference: Small <22 cm | Normal 22–32 cm | Large 33–42 cm
Measure BP in both arms simultaneously and
Two sets of BP measurements at 1 minute intervals
Total of 4 sets are used in the calculator
Prophylaxis for Women at High Risk
Aspirin for prevention of preterm preeclampsia
Start between 11w0d to 14w6d
~150 mg every night until
36 weeks | Delivery | Preeclampsia diagnosed
Do not prescribe low-dose aspirin for all
Low calcium intake (<800 mg/d)
Calcium replacement: ≤1 g elemental calcium/d or
Calcium supplementation: 1.5–2 g elemental
Combined algorithm “can be adapted” for twins
High detection but also high screen-positive
ACOG and SMFM Guidance
ACOG and SMFM have released guidance, stating
that they “support the USPSTF guideline criteria for prevention of
preeclampsia” on the use of low-dose aspirin during pregnancy to prevent
preeclampsia (see ‘Related ObG Topics’ below)
Offer low-dose aspirin (81 mg/day) to women with
≥1 high risk factors for preeclampsia
Risk factors used for ACOG/SMFM recommendations
only include factors obtained from the medical record
Uterine artery Doppler ultrasonography and
biochemical markers are not included
ACOG considers the supporting data for the use
of such combined risk assessment algorithms to be limited and without more
prospective clinical utility trials, states that
…biomarkers and ultrasonography cannot accurately predict preeclampsia and should remain investigational
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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