On April 25, the U.S. Preventive Services Task Force (USPSTF) published its final recommendation statement(www.uspreventiveservicestaskforce.org) and final evidence summary(www.uspreventiveservicestaskforce.org) on screening for pre-eclampsia. The task force recommended screening pregnant women for pre-eclampsia throughout pregnancy using blood pressure measurements -- a "B" recommendation.(www.uspreventiveservicestaskforce.org)
Pre-eclampsia is a complex syndrome defined by new-onset hypertension in pregnant women after 20 weeks of gestation and can trigger maternal complications such as stroke, seizures and organ failure. Related complications for infants can include intrauterine growth retardation, low birth weight and even death. In severe cases, infants may be delivered before their due date.
"Pre-eclampsia can progress quickly and lead to severe complications for both the mother and infant," said USPSTF member Maureen Phipps, M.D., M.P.H., in a news bulletin.(www.uspreventiveservicestaskforce.org) "It is critical that women be screened for pre-eclampsia during every clinical visit throughout their pregnancy."
This final recommendation applies to pregnant women without a current diagnosis of pre-eclampsia and no symptoms of pre-eclampsia or hypertension. It is largely consistent with the task force's 2016 draft and 1996 final recommendation statements, both of which affirm the importance of screening for pre-eclampsia.
- On April 25, the U.S. Preventive Services Task Force recommended screening pregnant women for pre-eclampsia throughout pregnancy using blood pressure measurements.
- This final recommendation applies to pregnant women without a current diagnosis of pre-eclampsia and no symptoms of pre-eclampsia or hypertension.
- The final recommendation is largely consistent with the task force's 2016 draft and 1996 final recommendation statements, both of which affirm the importance of screening for pre-eclampsia.
Additionally, it's important to note that this final recommendation addresses routine screening 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) prophylaxis after 12 weeks' gestation.
The AAFP released a parallel recommendation on prophylactic use of low-dose aspirin at that time.
Response to Public Comment
The draft version of the current routine screening recommendation statement was posted for public comment on the USPSTF website from Sept. 27 to Oct. 24, 2016.
Some commenters asked the task force to further explain the role of urine protein dipstick testing in diagnosing pre-eclampsia. In response, the USPSTF addressed testing for proteinuria in the Clinical Considerations(www.uspreventiveservicestaskforce.org) and Rationale(www.uspreventiveservicestaskforce.org) sections of the recommendation statement, including addressing the respective sensitivities and specificities of this testing method and others.
A number of commenters requested more information on screening intervals, which the final recommendation discusses in its Clinical Considerations section. Others asked for clarification on risk prediction of pre-eclampsia. In response, the USPSTF added information about risk prediction models to the Rationale and Discussion(www.uspreventiveservicestaskforce.org) sections.
Notes From the AAFP
In September 2016, when the draft recommendation on this topic was released, Jennifer Frost, M.D., medical director for the AAFP Health of the Public and Science Division, told AAFP News the draft screening recommendation shouldn't significantly affect how family physicians care for pregnant women; monitoring these patients' blood pressure at each prenatal visit already is standard care.
"It shouldn't change how family physicians practice," said Frost at the time, "but instead remind them of why they are checking blood pressure and the importance of further evaluation when blood pressure is elevated.
"Pre-eclampsia can result in serious complications for both the mother and fetus, so it is essential that it is recognized early."
Regarding this final USPSTF recommendation statement, Melanie Bird, Ph.D., AAFP clinical policies strategist, told AAFP News that the Academy's Commission on Health of the Public and Science Subcommittee on Clinical Preventive Services still needs to review the task force's final evidence summary before the AAFP offers its own final recommendation on routine pre-eclampsia screening.
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