USPSTF recommends screening for preeclampsia in pregnant women

After reviewing the available evidence, the U.S. Preventive Services Task Force (USPSTF) recommended physicians obtain blood pressure measurements and screen for preeclampsia in women throughout pregnancy.

The recommendation statement was published online in JAMA on April 25. The USPSTF considered this a “B” grade recommendation, which meant there was moderate certainty that screening for preeclampsia in pregnant women offers substantial net benefit.

Approximately 4 percent of pregnant women have preeclampsia, which the authors defined as hypertension occurring after 20 weeks of gestation combined with new-onset proteinuria or other signs of symptoms involving multiple organ systems. The condition is the second leading cause of maternal mortality worldwide, according to the authors.

Factors associated with an increased risk for preeclampsia include a history of eclampsia or preeclampsia, a previous adverse pregnancy outcome, maternal comorbid conditions, multifetal gestation, nulliparity, obesity, African American race, low socioeconomic status and advanced maternal age. The authors noted that African American women are three times more likely to die of preeclampsia than white women.

The USPSTF found there was adequate evidence regarding the accuracy of blood pressure measurements to screen for preeclampsia. The agency recommended using sphygmomanometry as the preferred method for measuring blood pressure during pregnancy. It also found inadequate evidence regarding the evidence of clinical indicators, serum markers, uterine artery pulsatility index and other risk prediction tools for preeclampsia.

When physicians diagnose preeclampsia, the USPSTF recommends closely monitoring the women and fetus and prescribing antihypertensive medications and magnesium sulfate. The agency also recommends using low-dose aspirin after 12 weeks of gestation in women who are at high risk for preeclampsia.

The USPSTF’s recommendations differ from other organizations in some ways. For instance, the American College of Obstetricians and Gynecologists recommends measuring blood pressure at every prenatal visit and evaluating risk factors for preeclampsia via a detailed medical history. Meanwhile, the National Institute for Health and Care Excellence in the United Kingdom recommends measuring blood pressure and conducting a urinalysis for proteinuria at each antenatal visit. In addition, the Society of Obstetricians and Gynecologists of Canada recommends assessing proteinuria in all pregnant women and diagnosing hypertension based on office or in-hospital blood pressure measurements.

The USPSTF said that future trials should examine the pathophysiology of preeclampsia, variations in current preeclampsia screening practices in various healthcare settings, screening algorithms, risk prediction tools and the effects of changing diagnostic criteria on screening practices.