Grant: Knowledge Synthesis Grant

Unity Health Toronto

$90,000.00

Optimizing the timely initiation of aspirin prophylaxis in pregnancy based on risk factors in a prior and current pregnancy. A knowledge synthesis grant.

FY 2014-15

Summary

Few methods exist to prevent preeclampsia (PE) & related adverse perinatal outcomes. The relevance for parents, the child & society is immense. Randomized clinical trials (RCTs) established that aspirin (ASA) prophylaxis starting at 12-16 weeks of pregnancy reduces the risk of these adverse outcomes, especially PE. Major Canadian oversight bodies recommend ASA prophylaxis among “high risk” mothers. Yet, we currently lack a sufficient tool for clinicians to identify, in early pregnancy, such high-risk women. This gap in knowledge will be addressed by this Knowledge Synthesis grant. For those who provide prenatal care to women (physicians, midwives & nurses), we will produce a ready-to-use set of risk factors that enable one to optimally identify women at high risk of PE who should be started on ASA. We will develop an end-user tool for clinicians & regional public health units. We will complete a systematic pooled analysis of the risk factors for PE identified within observational studies (Step 1, Objectives 1a & 1b). We will then systematically examine the published RCTs to determine the relative risk of ASA vs. placebo, stratified by maternal risk factors (Step 2, Objective 2). We will complete a two-round RAND/UCLA panel method, including a policy roundtable meeting (Step 3, Objective 3), followed by the creation & dissemination of a simple, end-user handout and APP that identifies women at high risk for PE and outlines who warrants ASA prophylaxis (Steps 4a/4b, Objectives 4a/4b). Our team comprises scientific & policy informants who define care priorities & practice guidelines for the care of pregnant women & infants. They include Marilyn Booth (Principal Knowledge User, Executive Director of the Ontario Provincial Council for Maternal & Child Health); Jennifer Blake (President of SOGC); John Kingdom (Chair, Dept. of Obstetrics & Gynaecology at U of T and Co-author of the SOGC Guideline on “Intrauterine Growth Restriction”); Vicki Van Wagner (Midwife & member of Clinical Practice Guideline Subcommittee of the Association of Ontario Midwives); Lisa Graves (Chair, Maternal & Newborn Care Program Committee, College of Family Physicians of Canada [CFPC]). Our team members agree that we need a better method of identifying, at the individual & population level, women at high risk of PE, in which ASA prophylaxis is warranted. Hence, we have the skills & expert users to complete an evidence-informed health prevention program that is likely to reduce the rates of PE and related preterm birth, fetal growth restriction & perinatal death. After completion of Steps 1-4 (i.e., after dissemination of the tool and completion of this proposed ASA Knoweldge Synthesis initiative), we may decide to evaluate changes in the annual prevalence of PE, prematurity, stillbirth & SGA, using existing BORN Ontario datasets. If proven successful in Ontario, then by partnering with SOGC, Canadian Association of Midwives, CFPC, Canadian Perinatal Surveillance System & individual provincial perinatal groups, we could share this tool with other provincial obstetrics, midwifery, family medicine and perinatal surveillance groups.

Department

Canadian Institutes of Health Research

Program

Knowledge Synthesis Grant

Recipient

Unity Health Toronto

Location

Ontario, Canada

Recipient Type

Other

Type

Grant

Source

CIHR Funding Decisions Database

As published

308780

Name

Ray Joel G

Region

Ontario

Country

Canada

Orgtype

Institution Paid; Research Institution

Instname2

Health Services and Policy Research

Theme2

Health systems / services

Prcname2

Knowledge Synthesis Grant

Projecttitle

Optimizing the timely initiation of aspirin prophylaxis in pregnancy based on risk factors in a prior and current pregnancy. A knowledge synthesis grant.

Programtype2

Operating Grants

Orgnameinp2

Unity Health Toronto

Cihramount2

$90,000

Cihrequipment2

Programname2

Knowledge Synthesis Grant

Keyworddelim

Asa; Aspirin Prophylaxis; Hypertension In Pregnancy; Maternal And Newborn Health; Placenta; Preeclampsia; Pregnancy; Prenatal Care; Small For Gestational Age (Sga); Stillbirth

Abstract

<html> <body> Few methods exist to prevent preeclampsia (PE) & related adverse perinatal outcomes. The relevance for parents, the child & society is immense. Randomized clinical trials (RCTs) established that aspirin (ASA) prophylaxis starting at 12-16 weeks of pregnancy reduces the risk of these adverse outcomes, especially PE.  Major Canadian oversight bodies recommend ASA prophylaxis among “high risk” mothers. Yet, we currently lack a sufficient tool for clinicians to identify, in early pregnancy, such high-risk women. This gap in knowledge will be addressed by this Knowledge Synthesis grant. For those who provide prenatal care to women (physicians, midwives & nurses), we will produce a ready-to-use set of risk factors that enable one to optimally identify women at high risk of PE who should be started on ASA. We will develop an end-user tool for clinicians & regional public health units. We will complete a systematic pooled analysis of the risk factors for PE identified within observational studies (Step 1, Objectives 1a & 1b). We will then systematically examine the published RCTs to determine the relative risk of ASA vs. placebo, stratified by maternal risk factors (Step 2, Objective 2). We will complete a two-round RAND/UCLA panel method, including a policy roundtable meeting (Step 3, Objective 3), followed by the creation & dissemination of a simple, end-user handout and APP that identifies women at high risk for PE and outlines who warrants ASA prophylaxis (Steps 4a/4b, Objectives 4a/4b). Our team comprises scientific & policy informants who define care priorities & practice guidelines for the care of pregnant women & infants. They include Marilyn Booth (Principal Knowledge User, Executive Director of the Ontario Provincial Council for Maternal & Child Health); Jennifer Blake (President of SOGC); John Kingdom (Chair, Dept. of Obstetrics & Gynaecology at U of T and Co-author of the SOGC Guideline on “Intrauterine Growth Restriction”); Vicki Van Wagner (Midwife & member of Clinical Practice Guideline Subcommittee of the Association of Ontario Midwives); Lisa Graves (Chair, Maternal & Newborn Care Program Committee, College of Family Physicians of Canada [CFPC]). Our team members agree that we need a better method of identifying, at the individual & population level, women at high risk of PE, in which ASA prophylaxis is warranted. Hence, we have the skills & expert users to complete an evidence-informed health prevention program that is likely to reduce the rates of PE and related preterm birth, fetal growth restriction & perinatal death. After completion of Steps 1-4 (i.e., after dissemination of the tool and completion of this proposed ASA Knoweldge Synthesis initiative), we may decide to evaluate changes in the annual prevalence of PE, prematurity, stillbirth & SGA, using existing BORN Ontario datasets. If proven successful in Ontario, then by partnering with SOGC, Canadian Association of Midwives, CFPC, Canadian Perinatal Surveillance System & individual provincial perinatal groups, we could share this tool with other provincial obstetrics, midwifery, family medicine and perinatal surveillance groups. </body> </html>

Competitiondate

201404

Approvedterm2

1 yr 0 mth

Pinamesdelim

Ray, Joel G; Booth, Marilyn B

Approvedterm

1 an 0 mois

Cihrcontribution2

~ $90,000~ $0~

View source data CIHR Funding Decisions Database (Canadian Institutes of Health Research)