USPSTF recommends screening for hypertensive disorders of pregnancy during every prenatal visit
USA: The USPSTF (United States Preventive Services Task Force) has recommended screening for hypertensive disorders in pregnant women with blood pressure measurements throughout pregnancy (B recommendation). The recommendation statement was published online in the Journal of the American Medical Association (JAMA) on September 19, 2023.
According to the recommendation statement, to achieve the benefit of screening, persons who screen positive must receive evidence-based management of hypertensive disorders of pregnancy.
The B recommendation is consistent with the 2017 USPSTF statement that recommended preeclampsia screening but now broadens that to include screening for all hypertensive disorders. This included chronic or preexisting hypertension which is diagnosed before pregnancy or within the first 20 gestation weeks, preeclampsia, gestational hypertension (new-onset hypertension after 20 weeks of gestation), and eclampsia.
The USPSTF continues to recommend aspirin after 12 weeks gestation as a preventive measure for people at high risk for preeclampsia, which is also a B recommendation as part of the 2017 statement.
Hypertensive disorders of pregnancy are among the main causes of maternal mortality and morbidity in the US. There has been a rise in the rate of hypertensive disorders of pregnancy from about 500 cases per 10,000 deliveries in 1993 to 1021 cases per 10,000 deliveries in 2016 to 2017.
The USPSTF commissioned a systematic review to assess the harms and benefits of screening for hypertensive disorders of pregnancy. It included pregnant women without a known diagnosis of a hypertensive disorder of pregnancy or chronic hypertension.
The task force concluded with moderate certainty that screening for hypertensive disorders in pregnancy with blood pressure measurements has substantial net benefit.
As part of the statement, the task force noted that there isn't adequate evidence on whether any other screening methods, such as home BP (blood pressure) monitoring could reduce perinatal and maternal mortality and morbidity when compared with office-based visits. This is another area for future research since early detection of hypertensive disorders might be possible.
Other research areas include the best approach to 'mitigate and detect' the consequences of hypertensive disorders that develop in the postpartum period. In the review of the evidence, the task force observed very limited research on screening in the postpartum period, something that is particularly needed to identify what screening intervals might be best to reduce morbidity and mortality in this period.
Reference:
US Preventive Services Task Force. Screening for Hypertensive Disorders of Pregnancy: US Preventive Services Task Force Final Recommendation Statement. JAMA. 2023;330(11):1074–1082. doi:10.1001/jama.2023.16991
