Quality statement 2: Antenatal assessment of pre-eclampsia risk

This quality statement updates and replaces Quality statement 7: Risk assessment – pre-eclampsia in Antenatal care (NICE quality standard 22).

Quality statement

Pregnant women at increased risk of pre-eclampsia at the booking appointment are offered a prescription of 75 mg of aspirin to take daily from 12 weeks until birth.

Rationale

Aspirin prophylaxis, unless contraindicated, reduces the occurrence of pre-eclampsia, preterm birth and fetal and neonatal mortality in women at increased risk of developing the condition (if they have 1 high risk factor or more than 1 moderate risk factor for pre-eclampsia).

Quality measures

Structure

a) Evidence of local arrangements to ensure that pregnant women have their risk factors for pre-eclampsia identified and recorded at the booking appointment.

Data source: Local data collection.

b) Evidence of local arrangements to ensure that pregnant women at increased risk of pre-eclampsia at the booking appointment are offered a prescription of 75 mg of aspirin (unless contraindicated) to take daily from 12 weeks until birth.

Data source: Local data collection.

Process

a) Proportion of pregnant women who have their risk factors for pre-eclampsia identified and recorded at the booking appointment.

Numerator – the number of women in the denominator whose risk factors for pre-eclampsia are identified and recorded.

Denominator – the number of pregnant women attending a booking appointment.

Data source: The Maternity Services Secondary Uses Dataset collects data on the following risk factors at booking: hypertension, renal disease, diabetes, autoimmune disease (global number 17200350) and obstetric diagnoses from previous pregnancies including 'severe pre-eclampsia' requiring preterm birth', 'eclampsia' and 'gestational hypertension' (global number 17200720).

b) Proportion of pregnant women at increased risk of pre-eclampsia at the booking appointment who are offered a prescription of 75 mg of aspirin (unless contraindicated) to take daily from 12 weeks until birth.

Numerator – the number of women in the denominator offered a prescription of 75 mg of aspirin to take daily from 12 weeks until birth.

Denominator – the number of pregnant women at increased risk of pre-eclampsia and without contraindications to aspirin at the booking appointment.

Data source: Local data collection.

Outcome

Incidence of pre-eclampsia in women at increased risk of developing pre-eclampsia.

Data source: The Maternity Services Secondary Uses Dataset collects data on obstetric conditions diagnosed in the current pregnancy, including severe pre-eclampsia, severe pre-eclampsia requiring preterm birth and eclampsia (global number 17203940).

What the quality statement means for service providers, healthcare practitioners and commissioners

Service providers ensure that systems are in place to offer pregnant women at increased risk of pre-eclampsia at the booking appointment a prescription of 75 mg of aspirin (unless contraindicated) to take daily from 12 weeks until birth.

Healthcare practitioners offer pregnant women at increased risk of pre-eclampsia at the booking appointment a prescription of 75 mg of aspirin (unless contraindicated) to take daily from 12 weeks until birth.

Commissioners ensure they commission services that offer pregnant women at increased risk of pre-eclampsia at the booking appointment a prescription of 75 mg of aspirin (unless contraindicated) to take daily from 12 weeks until birth.

What the quality statement means for patients, service users and carers

Pregnant women who have a higher risk of developing pre-eclampsia (a pregnancy-related rise in blood pressure with protein in the urine that happens in some pregnancies) are offered a prescription of aspirin (unless this is unsuitable) to take every day from 12 weeks of pregnancy until their baby is born.

Source guidance

Definitions of terms used in this quality statement

The booking appointment is the appointment where the woman enters the maternity care pathway. See Antenatal appointments (schedule and content) in NICE clinical guideline 62.

Contraindications to taking aspirin include, but are not limited to: aspirin allergy; medical conditions precluding the use of aspirin; present use of another drug with the potential to interact with aspirin.

Note: aspirin did not have UK marketing authorisation for the indication in question at the time of publication of NICE clinical guideline 107 (August 2010). Informed consent should be obtained and documented.

Increased risk of pre-eclampsia Women are at an increased risk of pre-eclampsia if they have 1 high risk factor or more than 1 moderate risk factor for pre-eclampsia.

High risk factors include:

  • hypertensive disease in a previous pregnancy

  • chronic kidney disease

  • autoimmune disease, such as systemic lupus erythematosus or antiphospholipid syndrome

  • type 1 or type 2 diabetes

  • chronic hypertension.

Moderate risk factors include:

  • first pregnancy

  • age 40 years or older

  • pregnancy interval of more than 10 years

  • body mass index (BMI) of 35 kg/m2 or more at first visit

  • family history of pre-eclampsia

  • multiple pregnancy.

Pre-eclampsia New hypertension presenting after 20 weeks of pregnancy with significant proteinuria (urinary protein:creatinine ratio greater than 30 mg/mmol or a validated 24‑hour urine collection result greater than 300 mg protein).