USPSTF Updates Guidance on Screening for Hypertensive Disorders of Pregnancy

Esa Davis, MD, MPH
Credit: USPSTF

The US Preventive Services Task Force (USPSTF) has released their latest recommendation statement, with this update focused on screening for hypertensive disorders of pregnancy.

Published on September 19, 2023, the final recommendation calls for screening for hypertensive disorders in pregnant persons with blood pressure measurements throughout pregnancy and was awarded a B grade, which indicates high certainty the net benefit is moderate or there is moderate certainty the net benefit is moderate to substantial.¹

“The Task Force continues to find that measuring blood pressure at each prenatal visit is an effective way to screen for hypertensive disorders of pregnancy,” said Task Force member Esa Davis, MD, MPH, professor of medicine and family and community medicine, the associate vice president of community health, and the senior associate dean of population health and community medicine at the University of Maryland School of Medicine.² “Because these conditions can cause serious health issues, screening is an important way to keep pregnant people and their babies healthy.”

The statement, which applies to all pregnant women and pregnant persons of all genders without a known diagnosis of a hypertensive disorder of pregnancy or chronic hypertension, is consistent with the USPSTF’s 2017 recommendation statement on screening for preeclampsia and is based on a targeted systematic review of evidence surrounding the effectiveness of screening for hypertensive disorders of pregnancy.¹ Through a search of the MEDLINE and the Cochrane Central Register of Controlled Trials for relevant studies published from January 1, 2014-January 4, 2022, investigators identified 6 studies comparing changes in prenatal screening practices with usual care. The total patient population from these 6 studies, which included 5 trials and 1 nonrandomized study, was 10,165 individuals.

Among the studies identified for inclusion, 1 trial examined home blood pressure measurement as a supplement to usual care, 3 trials examined reduced prenatal visit schedules, 1 study examined proteinuria screening conducted only for specific clinical indications compared with a historical control group that received routine proteinuria screening, and 1 trial only assessed the comparative harms of home blood pressure measurement.³

According to investigators, these studies did not report statistically significant differences in maternal and infant complications with alternate strategies compared with usual care, but estimates were imprecise for serious, rare health outcomes. Investigators also noted home blood pressure measurement was not associated with earlier diagnosis of a hypertensive disorders of pregnancy when added to prenatal care visits and there were no differences between groups in 3 trials of reduced prenatal visit schedules. Investigators identified no harms of different screening strategies.³

“Ensuring all pregnant people have their blood pressure taken is an important first step, but it is not enough to improve the inequities that our Black, Native American, and Alaska Native patients face related to hypertensive disorders of pregnancy,” said Task Force vice chair Wanda Nicholson, MD, MPH, MBA.² “We are using this recommendation to call for more research in this important area and to highlight promising ways to address these inequities and improve the health of those at increased risk.”

Within the final recommendation statement was a note reaffirming the importance of evidence-based management of hypertensive disorders of pregnancy among those who screen positive to achieve the benefit of screening.¹ Anna E. Denoble, MD, MSc, and Christian M. Pettker, MD, both of the Department of Obstetrics, Gynecology and Reproductive Sciences at Yale School of Medicine, echoed a similar sentiment in an editorial simultaneously published alongside the recommendation statement and evidence report.⁴

“While the tools for screening for hypertensive disorders of pregnancy remain limited, they can still be applied with skill and might,” wrote the pair.⁴ “However, addressing the larger maternal health crisis requires more and concerted efforts at multiple levels—national and local governments, communities, health care systems, and individuals and families—to reduce risk factors for hypertensive disorders of pregnancy, to conceive of innovative screening and treatment modalities, and to ensure recognition of warning signs and that the voices of pregnant and postpartum people are heard.”

References:

1. 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
2. US Preventive Services Task Force. Task Force Issues Final Recommendation Statement on Screening for Hypertensive Disorders of Pregnancy. September 19, 2023. Accessed September 19, 2023. https://www.uspreventiveservicestaskforce.org/uspstf/sites/default/files/file/supporting_documents/hypertensive-disorders-pregnancy-final-rec-bulletin.pdf.
3. Henderson JT, Webber EM, Thomas RG, Vesco KK. Screening for Hypertensive Disorders of Pregnancy: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2023;330(11):1083–1091. doi:10.1001/jama.2023.4934
4. Denoble AE, Pettker CM. Hypertension Screening in Pregnancy: Remembering the Basics, Charting the Future. JAMA. 2023;330(11):1040–1041. doi:10.1001/jama.2023.15088