A special task force is issuing recommendations for the first time in 20 years. Here's what they mean for your prenatal visits.
Preeclampsia is one of the most common—and dangerous—pregnancy complications, so you'd think the rules for doctors to follow would be pretty clear cut. But the last time the U.S. Preventive Services Task Force put out screening guidelines was over two decades ago, making it definitely time to check them over again. Here's what they found.
Pump up that blood pressure cuff
The disease is marked by rising blood pressure that can eventually lead to organ damage and seizures if not caught in time, so the task force says monitoring pregnant women's blood pressure at every prenatal checkup is essential. "The recommendation is that for every clinical encounter with their physician or provider, they have a blood pressure measurement done during that visit," co-author and task force member Maureen G. Phipps, MD, MPH, says in a podcast for the Journal of the American Medical Association, which published the report. "There's no specific timing interval, but it should be done with each visit with their doctor." OK, so that's no big deal since you probably already get your blood pressure checked all the time already.
But Phipps notes one thing that's changed recently is that protein in urine, measured during a pee test, isn't necessarily part of the condition's definition anymore. In other words, you can have the disease without excess protein in your pee. Although a urine test still is useful as a diagnostic tool once it's suspected a woman might be preeclamptic, it's not reliable for screening everyone. This could mean fewer routine urine tests, to the relief of every third tri lady who's tired of missing the cup—although those tests do measure other things too, so you might not be totally off the hook.
Who's at risk?
The task force notes that between four and five percent of all pregnancies become preeclamptic, which makes it a huge health issue. "The diagnosis and management of preeclampsia forms the basis of prenatal care in the U.S.," Michael Cackovic, MD, an OB/GYN at The Ohio State University Wexner Medical Center, who was not part of the task force, tells Fit Pregnancy. "It is why the nine-visit pathway exists [why women have between nine and 14 prenatal checkups], and why it is loaded towards more visits at the end of pregnancy," when preeclamptic symptoms usually begin. Treatment for the disease includes close monitoring, blood pressure meds and magnesium, but the only surefire cure is delivery.
Understandably, doctors want to err on the side of not missing anyone during screening. "As a rule, preeclampsia is overdiagnosed in the US and overmanaged," Cackovic says. "This is primarily due to the potential adverse outcomes that we want to prevent. I have been to many third-world countries where this is not the rule and seen devastating results." In addition to danger for moms, preeclampsia also puts babies at risk of not growing well in the uterus, having a low birth weight, having their placenta separate from the uterus, preterm delivery and other complications.
In figuring out who's most likely to develop the disease, the task force didn't find complicated "risk prediction models" to be accurate—and they rely on information not usually gathered at a prenatal visit (like special blood tests), so they can't be used for everyone anyway. Phipps says high-risk groups we know of include women who've had preeclampsia before, those who had diabetes or high blood pressure before pregnancy, who are overweight, or who are carrying more than one baby. The task force has previously recommended these women take baby aspirin after the first trimester as a preventative measure. But, these factors identify less than half of all women who develop preeclampsia, according to the report's accompanying editorial, so researchers are still on the hunt for ways to better identify those at risk.
How do these new guidelines affect you? Probably not much—but for your doctor, finding the best first line of defense is everything. "Guidelines refer only to the diagnosis and management of preeclampsia, and have little to do with patient perception of the disease," Cackovic says. If you have any concerns, talk to your doctor, and be sure to report symptoms such as headaches, severe abdominal pain with nausea, visual disturbances or increased facial swelling.