Pre-eclampsia is not uncommon during pregnancy, with an estimated 2 percent to 8 percent of pregnancies affected worldwide. About 9 percent of maternal deaths in the United States are directly attributed to pre-eclampsia and eclampsia -- with more than a third of severe obstetric complications associated with the condition.
Pre-eclampsia is a complex syndrome defined by new-onset hypertension in pregnant women after 20 weeks of gestation and can present complications for mothers including stroke, seizures and organ failure. Related complications for infants include intrauterine growth retardation, low birth weight and even death. In severe cases, babies often are delivered before their due date.
To address this issue, the U.S. Preventive Services Task Force (USPSTF) revisited the evidence regarding screening for pre-eclampsia and on Sept. 27 posted a draft recommendation statement(www.uspreventiveservicestaskforce.org) and draft evidence review(www.uspreventiveservicestaskforce.org) on the topic. Based on that evidence, the group recommended screening pregnant women for pre-eclampsia throughout pregnancy using blood pressure measurements -- a "B" recommendation.(www.uspreventiveservicestaskforce.org)
- On Sept. 27, the U.S. Preventive Services Task Force (USPSTF) posted a draft recommendation statement calling for pregnant women to be screened for pre-eclampsia with blood pressure measurements throughout pregnancy.
- The draft recommendation is in addition to the USPSTF's 2014 recommendation that women who are at high risk for pre-eclampsia use daily low-dose aspirin (81 mg) prophylactically after 12 weeks' gestation.
- The USPSTF is accepting public comments on this draft recommendation statement and draft evidence review until Oct. 24.
The new draft recommendation applies to all pregnant women without a current diagnosis of pre-eclampsia and no symptoms of the condition.
"Pre-eclampsia is a serious health problem affecting pregnant women and is a leading cause of preterm birth in the U.S.," said USPSTF member Maureen Phipps, M.D., M.P.H., in a news release.(www.uspreventiveservicestaskforce.org) "In order to improve outcomes for mothers and their babies, it is critical that women be screened for pre-eclampsia during every clinical visit throughout their pregnancy."
Draft Recommendation Reaffirms 1996 Guidance
Since 1996, when the task force released its previous recommendation on this subject, the clinical definition and identification of pre-eclampsia have changed, but the screening message remains essentially the same. In that 1996 recommendation, the USPSTF suggested screening all pregnant women for pre-eclampsia using office-based blood pressure measurement during their first prenatal visit and periodically throughout the remainder of the pregnancy -- also a B recommendation.
For the current draft recommendation, the task force commissioned an evidence review to systematically appraise and update the evidence on pre-eclampsia screening.
It's important to note that this draft recommendation addresses routine screening -- not targeted prophylaxis -- for pre-eclampsia and does not replace the USPSTF's 2014 recommendation(www.uspreventiveservicestaskforce.org) that women who are at high risk for pre-eclampsia (e.g., women with a history of pre-eclampsia or chronic hypertension) use low-dose aspirin (81 mg per day) after 12 weeks' gestation.
The AAFP released a parallel recommendation on prophylactic use of low-dose aspirin at that time.
Notes From the AAFP
According to Jennifer Frost, M.D., medical director for the AAFP Health of the Public and Science Division, the current draft screening recommendation shouldn't greatly affect how family physicians care for pregnant women because monitoring their blood pressure at every prenatal visit already is standard care.
"It shouldn't change how family physicians practice, but instead remind them of why they are checking blood pressure and the importance of further evaluation when blood pressure is elevated," she said. "Pre-eclampsia can result in serious complications for both the mother and fetus, so it is essential that it is recognized early."
Frost said the diagnostic criteria for pre-eclampsia have changed over the years, but the predominant sign has always been persistent elevated blood pressure. "Any pregnant woman who presents with elevated blood pressure should be further evaluated in order to diagnose pre-eclampsia," she said. "This includes repeated blood pressure measurements and blood and urine tests."
Finalizing the Draft Recommendation
The USPSTF is accepting public comments on this draft recommendation statement(www.uspreventiveservicestaskforce.org) and draft evidence review(www.uspreventiveservicestaskforce.org) until Oct. 24.
The AAFP will review the USPSTF's draft materials and release its own final recommendation after the task force finalizes its recommendation statement.
More From AAFP
American Family Physician: Update on Prenatal Care