Screening for preeclampsia throughout pregnancy recommended by USPSTF

Pregnant women should receive screening for preeclampsia with blood pressure measurements throughout pregnancy.
Pregnant women should receive screening for preeclampsia with blood pressure measurements throughout pregnancy.

Pregnant women should receive screening for preeclampsia with blood pressure measurements throughout pregnancy, according to a recommendation statement from the US Preventive Services Task Force (USPSTF) published in JAMA.

The task force gave a B grade to the recommendation, which updates the 1996 USPSTF recommendation on screening for preeclampsia. The USPSTF reviewed the evidence on the accuracy of screening and diagnostic tests for preeclampsia, the benefits and harms of screening for preeclampsia, the effectiveness of risk prediction tools, and the benefits and harms of treatment of screen-detected preeclampsia.

The task force found adequate evidence that screening for preeclampsia provides substantial benefit for the mother and infant. There is also adequate evidence that suggests the harms of preeclampsia screenings and treatment are small. The USPSTF concluded that there is substantial net benefit of preeclampsia screenings.

Blood pressure measurements are routinely used to screen for preeclampsia, and these measurements should be obtained during each prenatal care visit during pregnancy. If the patient has an elevated blood pressure reading, clinicians should confirm the reading with repeated measurements.

The task force note clinical conditions associated with increased risk of preeclampsia, including a history of eclampsia or preeclampsia, previous adverse pregnancy outcome, maternal comorbid conditions, and multifetal gestation. Additional risk factors include nulliparty, obesity, African American race, low socioeconomic status, and advanced maternal age.

The USPSTF notes that management strategies for diagnosed preeclampsia may include close fetal and maternal monitoring, antihypertension medications, and magnesium sulfate. The task force also recommends the use of low-dose aspirin (81 mg/d) as preventive medication after 12 weeks of gestation in women with a high risk of preeclampsia.

In response to public comment from the draft recommendation, the USPSTF has provided information on testing for proteinuria and added information about risk prediction models.

In an accompanying editorial, Martha Gulati, MD, MS, from the Division of Cardiology at the University of Arizona notes that blood pressure measurements are a simple and effective way to identify and treat at-risk women without additional substantial risks.

“Although risk assessment tools for preeclampsia are available, their low positive predictive value currently limits their usefulness for screening. Given the incidence of preeclampsia and the lack of predictability, it is important that all pregnant women have routine blood pressure assessments at every visit during the prenatal period,” Dr Gulati stated.

“It is important that we continue to fund and perform studies to help accurately identify women at risk for preeclampsia and to optimally treat a pregnant woman and maintain or improve the short-term and long-term health of the mother and the child.”

References

  1. Gulati M. Early identification of pregnant women at risk for preeclampsia: USPSTF recommendations on screening for preeclampsia. 2017. doi:10.1001/jamacardio.2017.1276
  2. US Preventive Services Task Force. Screening for preeclampsia: US Preventive Services Task Force recommendation statement. JAMA. 2017;317(16):1661-1667. doi:10.1001/jama.2017.3439
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