Screening for Hypertensive Disorders of Pregnancy

A 25-year-old woman presents for routine prenatal care at an estimated 20 weeks of gestation. This is her first pregnancy. The pregnancy has been uncomplicated so far, and she does not have any new symptoms. She has no significant medical history and takes no medications. At her last appointment, her blood pressure measurement was 118/58 mm Hg.

1. Based on the US Preventive Services Task Force (USPSTF) recommendation statement, when should this patient be screened for hypertensive disorders of pregnancy?

• A. Once, at 20 weeks of gestation (during this visit).
• B. Once, at 28 weeks of gestation.
• C. Once, at 36 weeks of gestation.
• D. During each prenatal visit, including this one.
• E. Once per trimester—before 12 weeks of gestation, at 13 to 27 weeks of gestation, and at 28 to 40 weeks of gestation.

2. According to the USPSTF recommendation statement, what is the most appropriate way to screen this patient for hypertensive disorders of pregnancy?

• A. With only a blood pressure measurement.
• B. With only a urine protein test.
• C. With only a blood test.
• D. With a blood pressure measurement and urine protein test.
• E. With a blood pressure measurement, urine protein test, and blood test.

3. Which of the following diagnoses are considered hypertensive disorders of pregnancy?

• A. Gestational hypertension.
• B. Preeclampsia.
• C. Eclampsia.
• D. Chronic hypertension with superimposed preeclampsia.

1. The correct answer is D. The USPSTF concluded with moderate certainty that screening for hypertensive disorders of pregnancy with blood pressure measurements has substantial net benefit.¹ The USPSTF carefully considers evidence of benefits and harms and makes recommendations when supported by sufficient evidence. Based on the evidence, the USPSTF recommends screening asymptomatic pregnant patients throughout pregnancy. A positive screening result for new-onset hypertension during pregnancy is defined as an elevated blood pressure reading (systolic blood pressure of at least 140 mm Hg or diastolic blood pressure of at least 90 mm Hg in the absence of chronic hypertension), measured twice, at least 4 hours apart.
2. The correct answer is A. The USPSTF recommends screening for hypertensive disorders of pregnancy using a blood pressure cuff that is sized appropriately for the patient based on their measured mid-arm circumference. The USPSTF found that the current evidence does not support screening with a urine protein test alone or in combination with blood pressure measurement.² If screening blood pressure measurements indicate that a person may have a hypertensive disorder of pregnancy, urine protein tests or blood tests may be used to confirm the diagnosis.
3. The correct answers are A, B, C, and D. Hypertensive disorders of pregnancy are among the leading causes of serious complications and death for pregnant people in the United States. These conditions can lead to complications for the pregnant person and the baby. Hypertensive disorders of pregnancy include gestational hypertension, preeclampsia, eclampsia, and chronic hypertension with superimposed preeclampsia. Gestational hypertension is defined as developing high blood pressure after 20 weeks of gestation after not previously having high blood pressure. Preeclampsia is defined as developing high blood pressure and signs or symptoms that organs are not working properly—such as high levels of protein in the urine—after 20 weeks of gestation. Eclampsia is defined as developing seizures during pregnancy with high blood pressure, after not previously having seizures. Chronic hypertension is present before pregnancy and typically diagnosed before pregnancy or within the first 20 weeks of gestation.