USPSTF to Recommend Preeclampsia Screening for All Pregnant Women

Troy Brown, RN

September 28, 2016

All pregnant women should be screened for preeclampsia by measuring blood pressure at each clinical prenatal visit, according to a new draft recommendation statement from the US Preventive Services Task Force (USPSTF). However, the evidence does not support point-of-care urine testing for preeclampsia screening.

"Preeclampsia is a serious health problem affecting pregnant women and is a leading cause of preterm birth in the US," task force member Maureen G. Phipps, MD, MPH, from Brown University, Providence, Rhode Island, and from the Women & Infants Hospital of Rhode Island and Care New England, said in a USPSTF news release. "In order to improve outcomes for mothers and their babies, it is critical that women be screened for preeclampsia during every clinical visit throughout their pregnancy."

"Although preeclampsia is usually accompanied by new-onset proteinuria, the American Congress of Obstetrics and Gynecology...recently revised the diagnostic criteria for preeclampsia so that the presence of proteinuria for diagnosis was no longer required, noting that elevated blood pressure accompanied by other signs and symptoms is sufficient for diagnosis," Jillian T. Henderson, PhD, MPH, and colleagues from Kaiser Permanente Research Affiliates Evidence-based Practice Center write in an accompanying systematic evidence review.

Further, there is inadequate evidence to support the effectiveness of risk prediction in identifying women with a high risk for preeclampsia. "There was no clear evidence of the performance, clinical benefits, or harms for any externally validated models for risk prediction, and the clinical performance and impact of risk prediction models could not be extrapolated to relevant patient settings," Dr Henderson and colleagues write.

Although other hypertension conditions overlap and can coexist with preeclampsia, preeclampsia is defined as a new onset of hypertension (or worsening hypertension in those with existing hypertension) after 20 weeks of gestation in combination with either a new onset of proteinuria or other signs or symptoms that involve multiple organ systems.

The clinical definition and identification of preeclampsia have changed since the USPSTF's last recommendation in 1996; however, the importance of screening is unchanged. The updated draft recommendation applies to pregnant women without a current diagnosis of preeclampsia or hypertension and those without signs or symptoms of preeclampsia, and it updates and reaffirms the 1996 final recommendation.

"If a patient has high blood pressure during a visit, she should receive further testing and evaluation," task force member William R. Phillips, MD, MPH, from the University of Washington, Seattle, and senior associate editor of the Annals of Family Medicine, said in the news release. "Multiple elevated blood pressure measurements are needed to diagnose preeclampsia."

The draft recommendation covers preeclampsia screening, not preventive medication for preeclampsia; therefore, it does not replace the USPSTF's 2014 recommendation that high-risk women take low-dose aspirin (81 mg/day) after 12 weeks of gestation for prevention.

"Although the USPSTF found no recent studies on the direct effectiveness of screening for preeclampsia in improving health outcomes, trial evidence and extensive clinical experience provide evidence of effective treatments for preeclampsia. Antihypertension medications, when indicated, and administration of magnesium sulfate reduce the risk of adverse events," the evidence review authors write.

The draft recommendation statement and draft evidence review on Screening for Preeclampsia are available for public comment on the Task Force website through October 24, 2016.

The American College of Obstetricians and Gynecologists (ACOG) released a statement from ACOG President Thomas Gellhaus, MD, regarding the draft recommendations: "These recommendations complement ACOG's current guidance, wherein ACOG recommends using a detailed medical history to evaluate for risk factors for predicting preeclampsia. Ob-gyns already take a woman's blood pressure at each routine, regularly scheduled visit, along with her weight, uterine size, and the presence of fetal heart activity. However, ACOG applauds the USPSTF in recommending an evidence-based screening tool that builds upon routine prenatal care.

"Early identification of pregnant women at risk of developing early-onset preeclampsia is important in order to allow referral for more intensive surveillance or the application of therapies to prevent the condition from becoming more severe. Importantly, ACOG has found there are no accurate, predictive tests at this time to determine whether a woman will develop preeclampsia and therefore continues to recommend against other methods for predicting preeclampsia. A detailed medical history and routine blood pressure measurements are the best tools available to alert ob-gyns of a potential risk."

The authors have disclosed no relevant financial relationships.

"Draft Evidence Review: Preeclampsia: Screening" USPSTF. Full text

"Draft Recommendation Statement: Preeclampsia: Screening." USPSTF. Published online September 27, 2016. Full text

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