Task force advises routine preeclampsia screening in pregnancy

Waiting for a baby. Close-up of young pregnant woman touching her abdomen while sitting on the couch (iStock)

Pregnant women should get routine blood pressure checks at every prenatal visit to screen for preeclampsia, according to new proposed U.S. guidelines aimed at preventing deaths from this complication.

Even though many doctors already monitor blood pressure throughout pregnancy, the U.S. Preventive Services Task Force (USPSTF), a government-backed panel of independent physicians, is updating its clinical guidelines for the first time since 1996 to reflect emerging evidence on the best way to detect preeclampsia.

"The Task Force recognizes the seriousness of this condition, which can progress quickly and become severe, and we continue to recommend pregnant women get screened for preeclampsia," task force member Dr. Maureen Phipps, a women's health researcher at Brown University in Providence, Rhode Island, said by email.

Preeclampsia is a relatively common high blood pressure disorder in pregnancy, affecting approximately 4 percent of pregnancies in the U.S., according to the draft Task Force statement.

In addition to elevated blood pressure, women with preeclampsia may also have excess amounts of protein in their urine, as well as swelling in the feet, legs and hands.

When it's undetected or untreated, the condition can lead to serious complications for both mother and baby.

Women may suffer from stroke, seizures, organ failure and in rare cases, death. For babies, complications include slower growth inside the uterus, low birth weight and death.

The condition is sometimes managed with bed rest or medications to lower blood pressure. If preeclampsia worsens, however, doctors may need to deliver babies well in advance of their due dates.

The draft recommendations update guidance from 1996 advising doctors to screen for preeclampsia with a blood pressure test at the first prenatal visit and then "periodically throughout the remainder of the pregnancy."

It's unlikely that the new guidelines would change the way doctors approach screening, said Dr. Christopher Zahn, vice president of practice activities for the American College of Obstetricians and Gynecologists (ACOG).

"We have supported blood pressure measurement at every visit," Zahn said by email. "The recommendations reinforce our clinical guidelines."

What's less clear is the best way to identify women who don't have preeclampsia but may be at risk for developing it.

Risks for preeclampsia include a history of obesity, diabetes, kidney disease, lupus or rheumatoid arthritis, as well as a mother or sister who has experienced the condition.

Women who have a high risk of developing preeclampsia may take low-dose aspirin during pregnancy as a preventive measure, the Task Force has previously recommended.

The condition can progress quickly, and typically develops after 20 weeks of pregnancy.

Blood pressure screening earlier in pregnancy can show normal results for women who go on to develop preeclampsia, the Task Force notes.

"Management of women with preeclampsia varies depending on when in pregnancy that it develops, as well as the degree of severity," Zahn said.

"Milder cases may be managed by close observation, with the pregnancy continuing, depending again on when in pregnancy it is diagnosed," Zahn added. "Severe cases may necessitate preterm delivery, as well as the use of medications to prevent eclampsia and to control blood pressure."