Preeclampsia Screening: Updated Recommendations From USPSTF

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Urine testing to detect proteinuria, however, was not found to be useful as part of preeclampsia screening.
Urine testing to detect proteinuria, however, was not found to be useful as part of preeclampsia screening.

Pregnant women should be screened for preeclampsia with regular blood pressure measurements during pregnancy, according to a recommendation statement by the US Preventive Services Task Force (USPSTF) published in JAMA.1

Preeclampsia — which involves new or worsening hypertension after 20 weeks of gestation plus proteinuria or multiple organ dysfunction — occurs in 4% of pregnancies in the United States.2

Maureen Phipps, MD, a USPSTF member from the Warren Alpert Medical School of Brown University in Providence, Rhode Island, told Cardiology Advisor that “preeclampsia is one of the most serious health problems affecting pregnant women.”

Maternal complications of preeclampsia include organ failure, stroke, and eclampsia, and fetal complications include low birth weight and stillbirth. Some of these complications may lead to preterm birth by early labor induction or cesarean delivery. Preeclampsia is the second most common cause of death in pregnant women.3,4

Preeclampsia is characterized by an unpredictable course and can suddenly worsen without warning. Early diagnosis and treatment of preeclampsia can help prevent serious complications and mortality.

According to the 1996 USPSTF recommendation5 for preeclampsia screening, blood pressure measurements should be taken “at the first prenatal visit and periodically throughout the remainder of the pregnancy.” The USPSTF undertook a review of the current evidence to update its recommendation for preeclampsia screening.

“After reviewing the evidence, the Task Force found the benefits of screening for preeclampsia outweighed the harms and recommended screening pregnant women for preeclampsia with blood pressure measurements throughout pregnancy,” Dr Phipps said. “The evidence showed mothers and their babies are likely to benefit from screening, as screening leads to treatment that reduces their risk of severe complications, including death.”

The USPSTF now recommends screening all pregnant women for preeclampsia by measuring blood pressure at each prenatal care visit, and more frequently if blood pressure readings are high.

However, point-of-care urine testing to detect proteinuria, which is one of the diagnostic criteria for preeclampsia, was not found to be useful as part of screening for preeclampsia.

The USPSTF also recommends that women who are at high risk for preeclampsia should take low-dose aspirin (81 mg/d) as preventive treatment.

Dr Phipps noted that additional research on screening for preeclampsia is needed: “There are several important areas for research that could help clinicians and their patients better understand subtypes of preeclampsia and the risks to a mother and her baby's health.”

“Once preeclampsia is more clearly defined, screening tools targeting various subtypes and different study populations may be necessary. Additionally, studies are needed to further develop and validate rigorous assessment tools to identify who is at greatest risk for developing preeclampsia,” Dr Phipps said.

References

  1. US Preventive Services Task Force; Bibbins-Domingo K, Grossman DC, Curry SJ, et al. Screening for preeclampsia: US Preventive Services Task Force Recommendation Statement. JAMA. 2017;317(16):1661-1667. doi:10.1001/jama.2017.3439
  2. Ananth CV, Keyes KM, Wapner RJ. Preeclampsia rates in the United States, 1980-2010: age-period-cohort analysis. BMJ. 2013;347:f6564. doi:10.1136/bmj.f6564
  3. Huppertz B. Placental origins of preeclampsia: challenging the current hypothesis. Hypertension. 2008;51(4):970-975. doi:10.1161/HYPERTENSIONAHA.107.107607
  4. Ghulmiyyah L, Sibai B. Maternal mortality from preeclampsia/eclampsia. Semin Perinatol. 2012;36(1):56-59. doi:10.1053/j.semperi.2011.09.011
  5. Screening for preeclampsia. In: US Preventive Services Task Force, eds. Guide to Clinical Preventive Services: Report of the US Preventive Services Task Force. 2nd ed. Baltimore, MD: Williams & Wilkins; 1996.
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