Background

Prenatal Screening Ontario (PSO) is housed within BORN Ontario and is funded by the Ministry of Health (MOH).  Its mandate is to coordinate and oversee the operations of prenatal screening services in Ontario, to maintain an integrated program that operates as a “system of care”. PSO depends on input from experts and advisors from relevant fields to ensure inclusion of all elements of a robust screening program.   

Preeclampsia is a significant cause of maternal and infant morbidity and mortality both in Canada and internationally. The incidence of preeclampsia in Ontario is 4% (unpublished BORN data), affecting 5800 pregnant individuals across the province each year.  Preeclampsia has significant implications for both mothers and babies, with more severe cases leading to worse outcomes. Preterm preeclampsia (requiring birth <37 weeks gestation), occurs in approximately 0.8% of pregnancies (unpublished BORN data), and causes the greatest adverse impact on maternal and perinatal outcomes, as well as being associated with the most concerning long-term impacts on maternal and child health. 

Compelling evidence now exists showing that systematic population wide screening for preterm preeclampsia, and treatment with low dose aspirin for those at high risk prevents many cases of preeclampsia and prevents the short and long-term adverse outcomes for pregnant individuals and their babies.  

Ontario Health Quality recently completed a Health Technology Assessment (HTA) on population-wide screening in the first trimester of pregnancy to predict the risk of preeclampsia. This HTA recommended to publicly fund a population-wide first-trimester preeclampsia screening program using the screening algorithm developed by the Fetal Medicine Foundation. Following on this recommendation, the MOH is seeking advice on implementation considerations should this testing be made available in Ontario.  

Mandate and Scope

PSO is seeking evidence-based and clinical/scientific expert advice on the implementation of first-trimester preeclampsia screening in Ontario.    

Task force members will leverage the HTA on a “First-Trimester Screening Program for the Risk of Pre-eclampsia Using a Multiple-Marker Algorithm” to inform a set of recommendations around the implementation of first-trimester preeclampsia screening in Ontario.    

The Task Force is asked to consider:  

1. Considerations for program governance  
2. Administration and adaptation of the multiple marker algorithm for different scenarios in Ontario, and potential integration into the existing aneuploidy screening program  
3. Patient care pathways and implications for current prenatal screening system   
4. Quality assurance of the system (e.g., screening markers and other key performance indicators)  
5. Data management and reporting  
6. Knowledge translation and practice change management  
7. Relative cost analysis of implementation and the proposed screening system  

While the expertise, advice and recommendations of the Task Force are essential to the process, the final decision on funding decisions or the implementation approach remain that of the Ministry.

Membership

The membership will be interdisciplinary, representing the following areas of expertise:   

• Clinical knowledge of high-risk pregnancy and current screening for these (e.g., expertise in maternal-fetal medicine)  
• Screening systems (e.g., technical, quality, policy, economics, epidemiology, public health, ethics)  
• Antenatal care (e.g., ultrasonography, primary care, midwifery)  
• Knowledge Translation   
• Laboratory medicine (biochemistry)  
• Health Equity   
• Primary care practitioner servicing rural/remote/underserviced areas 

The committee will be comprised of a maximum of 8-10 members, including a chair and co-chair.  Members will be chosen to meet the required content expertise and, where possible, to also provide geographic/regional/subspecialty representation.  

Effort will be made to obtain province-wide geographical representation and representation from equity-seeking groups. Equity-deserving groups are communities that face significant collective challenges participating in society.  Ideally, membership will be from within Ontario however it is recognized that there may be value in pulling membership nationally.  

MOH will participate as a non-voting member to observe and provide insight on MOH context and guidance on matters of policy and program needs.   

Non-voting guests may be invited as required for their subject matter expertise.  

Administrative and resource support persons will be provided by PSO. 

Accountability

The Preeclampsia Screening Task Force will report to PSO and to the MOH. The Task Force will interact with other internal and external bodies as required to accomplish its tasks.  

This is a time-limited Task Force, with deliverables expected to be submitted by July 2023. Additional documents, including potential publications, may result from this Task Force.   

All meetings will be held by web conference. 

Procedures

The advice and recommendations developed by the Task Force should reflect the consensus of the whole group.  

The Chair and Co-chair will facilitate a consensus decision-making process that is inclusive and provides enough time for evaluation, discussion, proposed options, identification of concerns, and acceptable resolution of the items and/or issues under consideration.  

Members will agree to support a consensus decision or course of action and be willing to carry it out. Where members are unable to reach consensus, the Task Force will seek to develop a clear and balanced statement or summary detailing the item or issue of disagreement to outline the differing positions tabled and options considered.

Meetings

The Ontario Preeclampsia Screening Task Force will meet by web conference biweekly through deliverable completion. Additional meetings may be scheduled at the call of the Chair.   Meeting materials will be circulated at least 3 business days prior to the meeting for review. Members who cannot attend are asked to provide input via email.   

Meeting minutes will be taken for each meeting and maintained by PSO. Once reviewed by the co-chairs, meeting minutes will be circulated to the Task Force for review. Task Force members will have an opportunity to collectively approve the minutes at the next meeting.   

At the first meeting, the Task Force will develop its work plan.

Conflict of Interest

Members  whose personal or professional activities constitute a conflict of interest (COI) must disclose the nature and details of their conflict of interest to the Chair and Prenatal Screening Ontario prior to participating on the committee.  Activities considered to be in conflict of interest include, but are not limited to, direct ties to private industry and personal interests in developing related technologies, including patents and patents pending. Incumbent and existing members will disclose to the Chair, without delay, any actual or potential situations that arise which might be reasonably interpreted as either a conflict of interest or a potential conflict of interest. The Chair has the right to deny participation or excuse any member with a COI that is perceived to interfere with the deliverable.  

Code of Conduct

Members are expected to conduct themselves in an appropriate and professional manner.  This means engaging with others in the group with:

• Mutual respect
• Kindness
• Humility
• Honesty
• Trust
• Integrity

Confidentiality

Every member will respect the confidentiality of matters brought before the committee, subcommittee or any of its working groups. Meeting materials, including slides, are all to be considered confidential and may not be used outside committee work and may not be disclosed or shared with non-committee members. If such material is no longer confidential and may be circulated externally, the committee will be notified by the Chair. 

Compensation

Serving as a committee member is voluntary. A stipend will be provided to the Co-chairs. 

Date: February 28, 2023