In the Journals

USPSTF recommends preeclampsia screening for pregnant women

The U.S. Preventive Services Task Force recommends screening for preeclampsia with BP measurements throughout a patient’s pregnancy, according to a report recently released in JAMA.

Researchers noted that approximately 2% to 8% of all pregnancies are affected by preeclampsia, and that it is the second leading cause of maternity mortality worldwide.

The B-level recommendation — which means there is moderate certainty that the net benefit is substantial — came from analyzing 21 studies with 13,982 participants that measured maternal and infant health outcomes, including low birthweight, preterm birth, stillbirth, stroke and eclampsia; screening and risk prediction test performance; and harms of screening and risk assessment.

“Evidence to estimate benefits and harms of preeclampsia screening and the test performance of different screening approaches over the course of pregnancy was limited. Externally validated risk prediction models had limited applicability and lacked calibration and clinical implementation data needed to support routine use,” Jillian T. Henderson, PhD, Kaiser Permanente Northwest, and colleagues wrote. “Further research is needed to better inform risk-based screening approaches and improve screening strategies, given the complex pathophysiology and clinical unpredictability of preeclampsia.”

A USPSTF spokesperson stated that this recommendation is largely consistent with the task force’s draft recommendation from last fall and its 1996 final recommendation statements on the condition. The recommendation also complements a 2014 recommendation that women at high risk for preeclampsia take low-dose aspirin daily after 12 weeks of pregnancy to prevent preeclampsia.

Researchers noted that the American College of Obstetricians and Gynecologists recommends obtaining BP measurements at every prenatal visit and using a detailed medical history to evaluate for risk factors for preeclampsia.

The USPSTF also stated that current evidence does not support point-of-care urine testing to screen for preeclampsia, as evidence suggests that proteinuria by itself may not be a good predictor of preeclampsia health outcomes. The task force determined that there was inadequate evidence on the effectiveness of risk prediction tools such as uterine artery pulsatility index, serum markers or clinical indicators to support different screening strategies.

In a related editorial, Jeffrey D. Sperling, MD, MS, and Dana R. Gossett, MD, MSCI, both of the University of California, San Francisco, wrote that the USPSTF’s comments on currently available options for screening for preeclampsia underscores the medical community’s continued inability to develop effective screening tools, which could have profound effects on maternal and neonatal outcomes because there are effective prevention strategies for preeclampsia, including aspirin and appropriate weight gain.

“Identifying women at risk remains a ‘holy grail’ of obstetrics. It is disappointing that since completion of the most recent systematic reviews evaluating this topic, there is not an accurate screening test or predictive model for preeclampsia,” they wrote. “Preeclampsia screening strategies should consider the cost and adverse effects of identifying women at high risk, including maternal anxiety and increased prenatal appointments and antenatal testing. As the pathophysiology of preeclampsia becomes better understood, targeted tests beyond serial [BP] measurement will be developed to predict, prevent, and treat this challenging condition. Achieving these goals is a ‘holy grail’ of modern obstetrics and a task worth striving toward.”

References:

Bibbins-Domingo K, et al. JAMA. 2017;doi:10.1001/jama.2017.4413

Henderson JT, et al. JAMA. 2017;doi:10.1001/jama.2016.18315.

Sperling JD and Gossett DR. JAMA. 2017;doi:10.1001/jama.2017.2018.

Disclosure: The researchers report no relevant financial disclosures.

The U.S. Preventive Services Task Force recommends screening for preeclampsia with BP measurements throughout a patient’s pregnancy, according to a report recently released in JAMA.

Researchers noted that approximately 2% to 8% of all pregnancies are affected by preeclampsia, and that it is the second leading cause of maternity mortality worldwide.

The B-level recommendation — which means there is moderate certainty that the net benefit is substantial — came from analyzing 21 studies with 13,982 participants that measured maternal and infant health outcomes, including low birthweight, preterm birth, stillbirth, stroke and eclampsia; screening and risk prediction test performance; and harms of screening and risk assessment.

“Evidence to estimate benefits and harms of preeclampsia screening and the test performance of different screening approaches over the course of pregnancy was limited. Externally validated risk prediction models had limited applicability and lacked calibration and clinical implementation data needed to support routine use,” Jillian T. Henderson, PhD, Kaiser Permanente Northwest, and colleagues wrote. “Further research is needed to better inform risk-based screening approaches and improve screening strategies, given the complex pathophysiology and clinical unpredictability of preeclampsia.”

A USPSTF spokesperson stated that this recommendation is largely consistent with the task force’s draft recommendation from last fall and its 1996 final recommendation statements on the condition. The recommendation also complements a 2014 recommendation that women at high risk for preeclampsia take low-dose aspirin daily after 12 weeks of pregnancy to prevent preeclampsia.

Researchers noted that the American College of Obstetricians and Gynecologists recommends obtaining BP measurements at every prenatal visit and using a detailed medical history to evaluate for risk factors for preeclampsia.

The USPSTF also stated that current evidence does not support point-of-care urine testing to screen for preeclampsia, as evidence suggests that proteinuria by itself may not be a good predictor of preeclampsia health outcomes. The task force determined that there was inadequate evidence on the effectiveness of risk prediction tools such as uterine artery pulsatility index, serum markers or clinical indicators to support different screening strategies.

In a related editorial, Jeffrey D. Sperling, MD, MS, and Dana R. Gossett, MD, MSCI, both of the University of California, San Francisco, wrote that the USPSTF’s comments on currently available options for screening for preeclampsia underscores the medical community’s continued inability to develop effective screening tools, which could have profound effects on maternal and neonatal outcomes because there are effective prevention strategies for preeclampsia, including aspirin and appropriate weight gain.

“Identifying women at risk remains a ‘holy grail’ of obstetrics. It is disappointing that since completion of the most recent systematic reviews evaluating this topic, there is not an accurate screening test or predictive model for preeclampsia,” they wrote. “Preeclampsia screening strategies should consider the cost and adverse effects of identifying women at high risk, including maternal anxiety and increased prenatal appointments and antenatal testing. As the pathophysiology of preeclampsia becomes better understood, targeted tests beyond serial [BP] measurement will be developed to predict, prevent, and treat this challenging condition. Achieving these goals is a ‘holy grail’ of modern obstetrics and a task worth striving toward.”

References:

Bibbins-Domingo K, et al. JAMA. 2017;doi:10.1001/jama.2017.4413

Henderson JT, et al. JAMA. 2017;doi:10.1001/jama.2016.18315.

Sperling JD and Gossett DR. JAMA. 2017;doi:10.1001/jama.2017.2018.

Disclosure: The researchers report no relevant financial disclosures.