Screening for Preeclampsia Remains Relevant

Practice Watch |
May 5, 2017

Screening for Preeclampsia Remains Relevant

  1. Allison Bryant, MD, MPH

USPSTF continues to recommend that women be screened for hypertensive disorders of pregnancy.

  1. Allison Bryant, MD, MPH

Preeclampsia, which affects 4% of U.S. pregnancies, can contribute significantly to maternal and neonatal morbidity and mortality if not detected early and managed effectively. Screening for preeclampsia generally includes blood pressure monitoring during pregnancy, with additional urine and serum laboratory evaluations as needed. The U.S. Preventive Services Task Force (USPSTF) recently reviewed the evidence for preeclampsia screening during pregnancy.

Recognizing the burden of disease and its capacity to evolve quickly, the USPSTF concluded with moderate certainty, based on the available evidence, that preeclampsia screening with blood pressure measurement during pregnancy provides benefit without significant harm. Testing for urinary excretion of protein alone is not supported, as isolated proteinuria is not clearly associated with adverse obstetric outcomes. Use of risk prediction models for preeclampsia or related outcomes is not endorsed.

Comment

The USPSTF's reaffirmation of its recommendation to screen for preeclampsia with blood pressure checks during pregnancy should come as little surprise. This endorsement remains consistent with those of relevant U.S. and international professional societies; indeed, the structure of modern prenatal care — with its escalating frequency of office visits as the pregnancy approaches term — was designed with the diagnosis of preeclampsia in mind. It remains to be seen whether models of care that challenge the established paradigm (e.g., decreasing the frequency of antenatal visits in low-risk women, providing care in group settings, not routinely evaluating low-risk women for proteinuria), which may be associated with cost savings and other benefits, might be just as efficacious and safe.

Editor Disclosures at Time of Publication

  • Disclosures for Allison Bryant, MD, MPH at time of publication Editorial Boards Obstetrics and Gynecology; American Journal of Obstetrics and Gynecology; New England Journal of Medicine; Maternal and Child Health

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