Preeclampsia — a condition where blood pressure in a pregnant woman can rise to life-threatening levels — is a key complication obstetricians try and predict early in pregnancy.
While commercial tests are being marketed for use in the first trimester to predict the risk of early onset preeclampsia, new recommendations from the American College of Obstetricians and Gynecologists (ACOG) say there’s a lack of evidence that the tests offer any benefits, and they may do more harm than good.
Instead, ACOG is holding to its position that taking a detailed medical history to assess a woman’s risk factors in the first trimester is still the recommended screening approach for early-onset preeclampsia.
This approach should remain the only method of screening for preeclampsia until studies can prove that aspirin or other treatments reduce the incidence of preeclampsia among women who are considered at high risk, based on predictive tests conducted in the first trimester, ACOG said.
Preeclampsia occurs in 5 percent to 10 percent of pregnancies and can lead to preterm birth, complications and death in mothers, and also increase women’s long-term risk of heart disease, the group noted.
Two experts agreed with the ACOG guideline.
“If one undergoes a screening test when its effectiveness has not yet been established objectively — as in this case — there is potential for further unnecessary diagnostic testing, patient stress and the wasting of resources,” said Dr. Catherine Herway, assistant director of maternal-fetal medicine at Staten Island University Hospital in Staten Island, N.Y.
“A screening program should also be cost-effective,” she noted, and “screening the entire population [of pregnant women] for preeclampsia would be quite costly.”
Dr. Fahimeh Sasan is an assistant professor of obstetrics, gynecology and reproductive science at the Icahn School of Medicine at Mount Sinai, in New York City. She said the ACOG guidelines are “consistent” with policies at her hospital.
“I agree that currently taking a detailed personal patient history at the initial prenatal visit, including her past obstetrics history, are the most important aspects of triaging a woman to be at risk for developing preeclampsia later in the pregnancy,” she said.
“Having a high suspicion that a woman is at risk for developing preeclampsia allows the physician to monitor the patient closer throughout her pregnancy and be more vigilant in monitoring her blood pressure and looking for signs and symptoms,” Sasan said.
The new policy was published Aug. 19 in Obstetrics & Gynecology.
The U.S. National Institute of Child Health and Human Development has more about preeclampsia and eclampsia.