Issue: June 2017
April 25, 2017
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USPSTF recommends routine BP measurements for preeclampsia screening

Issue: June 2017
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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.

Perspective from Julie B. Damp, MD, FACC

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.