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USPSTF recommends routine BP measurements for preeclampsia screening
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The U.S. Preventive Services Task Force recommended routine BP measurements to screen for preeclampsia in women throughout pregnancy, according to a statement published in JAMA.
The grade B recommendation, which affects women who have not been diagnosed with preeclampsia or hypertension, is an update to the USPSTF’s 1996 recommendation and is consistent with a draft recommendation published in 2016.
“Preeclampsia can progress quickly and lead to severe complications for both the mother and infant,” Maureen G. Phipps, MD, MPH, USPSTF member, chair of the department of obstetrics and gynecology and assistant dean for teaching and research on women’s health at Warren Alpert Medical School of Brown University in Providence, Rhode Island, said in a press release. “It is critical that women be screened for preeclampsia during every clinical visit throughout their pregnancy.”
Preeclampsia affects 4% of pregnancies in the United States. Complications may arise in women who are not treated for preeclampsia, including seizures, stroke and organ failure. Low birth weight, delayed growth inside the uterus, preterm labor, placental abruption and death may result in infants with untreated mothers, according to the statement.
BP measurements has been previously recognized by USPSTF as being an accurate method of screening for preeclampsia. The USPSTF has found that detection of proteinuria using the dipstick test has “low diagnostic accuracy.” Risk prediction tools such as serum markers and clinical indicators have inadequate evidence that they are effective in supporting other screening strategies.
The USPSTF found adequate evidence on the benefit of preeclampsia treatments on both mother and infant. Both screening and treatment of preeclampsia confer a small amount of harm, according to the adequate evidence found by the USPSTF.
“More research on the complex pathophysiology of preeclampsia is needed to better understand and define its subtypes and their risks to maternal and perinatal health,” the USPSTF wrote in the recommendation. “Once preeclampsia is more clearly defined, screening tools targeting its various subtypes and different study populations may be necessary.”
In a related editorial, Jeffrey D. Sperling, MD, MS, clinical fellow of maternal-fetal medicine at the University of California in San Francisco, and Dana R. Gossett, MD, MSCI, professor, Grace Marie Waldrop Chair of Obstetrics and Gynecology, vice chair for UCSF Health Regional Women’s Health Strategy, and division director at University of California in San Francisco, wrote: “Preeclampsia screening strategies should consider the cost and adverse effects of identifying women at high risk, including maternal anxiety and increased prenatal appointments and antenatal testing. As the pathophysiology of preeclampsia becomes better understood, targeted tests beyond serial [BP] measurement will be developed to predict, prevent and treat this challenging condition.” – by Darlene Dobkowski
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Julie B. Damp, MD, FACC
This document is important because it raises awareness of the importance of this disease. Preeclampsia complicates a significant number of pregnancies in both the United States and globally. The recommendations to be on the alert for this disease and screen for it throughout pregnancy will impact the care of a lot of women.
This information will validate what a lot of providers are already doing in practice and emphasize the importance of screening measures that we know to be effective. The recommendations are to see women in the prenatal period, take a complete history that may reveal risk factors for preeclampsia, and routinely check BP throughout pregnancy.
There are quite a few knowledge gaps. There is a lot of room for us to learn about screening tools that adequately capture women at risk for developing preeclampsia. We know there are certain factors in women’s medical history that make them higher risk, but for an individual patient, predicting risk is still pretty difficult. A large area of investigation will be developing and validating effective multifaceted screening tools that allow us to determine level of risk for individual patients. In addition, there is opportunity for new markers of risk for preeclampsia to be developed.
These recommendations emphasize the importance of patients getting early and frequent prenatal care, including BP monitoring, so providers can screen for and detect preeclampsia and initiate preventive measures or treatment, lowering risk for both mom and baby.
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