USPSTF finalizes guidance on screening for hypertensive disorders of pregnancy

Key takeaways:

• The task force says to continue screening for hypertensive disorders throughout pregnancy.
• Evidence shows that measuring BP at each prenatal visit is the best approach vs. alternative screening.

The U.S. Preventative Services Task Force issued a final recommendation that all pregnant patients should have BP measured at each prenatal visit to identify and prevent complications of hypertensive disorders.

The B-grade recommendation aligns with the USPSTF’s draft recommendation from February and builds on the task force’s 2017 call for routine BP screenings for preeclampsia during pregnancy.

“The Task Force continues to find that measuring blood pressure at each prenatal visit is an effective way to screen for hypertensive disorders of pregnancy,” USPSTF member Esa Davis, MD, MPH, said in a press release. “Because these conditions can cause serious health issues, screening is an important way to keep pregnant people and their babies healthy.”

According to MMWR data, the prevalence of hypertensive disorders in pregnancy (HDP) among delivery hospitalizations rose from 13.3% to 15.9% from 2017 to 2019, and the prevalence was highest among women aged older than 45 years (31%), Black women (20.9%) and Native American or Alaska Native women (16.4%).

In an evidence report supporting the recommendation, Jillian T. Henderson, PhD, MPH, an academic researcher at Kaiser Permanente, and colleagues reviewed six “fair-quality” studies — five randomized controlled trials and one nonrandomized study of interventions with a historical control — comparing traditional in-office BP monitoring with alternative strategies, which included at-home BP measurements, reduced prenatal visit schedules for patients at low risk for complications of HDP, and protein urine screenings done only when indicated.

They ultimately found no evidence that alternative screening methods were more effective compared with routine BP screenings during in-person prenatal visits.

According to the task force, risk factors for HDP can include:

• a history of eclampsia or preeclampsia;
• a family history of preeclampsia;
• gestational diabetes or chronic hypertension;
• prior adverse pregnancy outcomes;
• having a higher BMI before pregnancy;
• being aged 35 years or older; and
• being pregnant with more than one baby, or the pregnancy being the patient’s first.

USPSTF Vice Chair Wanda Nicholson, MD, MPH, MBA, said measuring BP in all pregnant persons is “an important first step,” but it is not enough to eliminate inequities among Black, Native American and Alaskan Native women.

“We are using this recommendation to call for more research in this important area and to highlight promising ways to address these inequities and improve the health of those at increased risk,” Nicholson said in the release.

In a related editorial, Anna E. Denoble, MD, MSc, and Christian M. Pettker, MD — both OB/GYN specialists from Yale School of Medicine — noted that the United States is “mired in a maternal health crisis,” and they pointed to the limited number of studies supporting the USPSTF’s recommendations. For example, the fact that the evidence still only supports routine BP measurements at in-person prenatal visits — a practice established almost a century ago — shows a lack of research of alternative screening strategies, they said.

They added that effective HDP screenings are “only as good as the response to the results.”

“Clinicians must continue efforts to improve recognition and urgent management of abnormal screening results, in particular blood pressures considered in the ‘severe’ range,” they wrote. “Clinicians must listen to their patients and respond to early warning signs.”

References:

• Denoble A, Pettker C. JAMA. 2023;doi:10.1001/jama.2023.15088.
• Ford N, et al. MMWR Morb Mortal Wkly Rep. 2022;doi:10.15585/mmwr.mm7117a1.
• Henderson T, et al. JAMA. 2023;doi:10.1001/jama.2023.4934.
• Task Force issues final recommendation statement on screening for hypertensive disorders of pregnancy. https://www.uspreventiveservicestaskforce.org/uspstf/sites/default/files/file/supporting_documents/hypertensive-disorders-pregnancy-final-rec-bulletin.pdf. Published Sept. 19, 2023. Accessed Sept. 19, 2023.
• USPSTF. JAMA. 2023;doi:10.1001/jama.2023.16991.