USPSTF recommends routine preeclampsia screening throughout pregnancy

The U.S. Preventive Services Task Force has reaffirmed previous recommendations in its release of a draft statement calling for screening for preeclampsia in pregnant women.

The agency issued a B recommendation, concluding “with moderate certainty that there is a substantial net benefit of screening for preeclampsia in pregnant women with blood pressure measurements.”

In evaluating the detection of preeclampsia, the USPSTF reported adequate evidence on the accuracy of blood pressure measurements; it also found adequate evidence that using a dipstick test to measure protein in urine has a low diagnostic accuracy for proteinuria detection.

In assessing the benefits and harms of early detection and treatment, there was adequate evidence that harms in screening for and treating preeclampsia in women without a previous diagnosis of hypertension or preeclampsia were small. The USPSTF noted inadequate evidence on harms associated with risk prediction.

“Given the evidence that treatment can reduce poor maternal and perinatal health outcomes and the well-established accuracy of blood pressure measurements, the USPSTF found adequate evidence that screening for preeclampsia results in a substantial benefit for the mother and infant,” according to the draft. “In addition, there is adequate evidence to bound the harms of screening for and treatment of preeclampsia as no greater than small. Therefore, the USPSTF concludes with moderate certainty that there is a substantial net benefit of screening for preeclampsia in pregnant women.”

This recommendation served as an update to recommendations issued in 1996. The recommendation will be open to public comment through Oct. 24.

The American College of Gynecologists (ACOG) issued a statement regarding the draft recommendations, noting that hypertensive disorders during pregnancy, which can lead to complications such as maternal mortality, preterm birth and risk for cardiovascular disease, affects up to 10% of pregnancies.

“These recommendations complement ACOG’s current guidance, wherein ACOG recommends using a detailed medical history to evaluate for risk factors for predicting preeclampsia,” Thomas Gellhaus, MD, ACOG president, said in the release. “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.”

He said the recommendations confirm how obstetrician-gynecologists currently practice and will assist in caring for pregnant women and babies.

“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,” Gellhaus said. “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.”