Resumen de Screening for Preeclampsia and the USPSTF Recommendations
Jeffrey D. Sperling, Dana R. Gossett
Preeclampsia is a condition characterized by the new onset of hypertension after 20 weeks of gestation, with proteinuria, evidence of organ dysfunction, or both in a previously normotensive woman.1 Preeclampsia and eclampsia complicate up to 10% of pregnancies and remain a leading cause of maternal and neonatal morbidity and mortality in the United States.2 The complications of preeclampsia in part shaped the development of prenatal care in the United States. The timing and frequency of visits were chosen to improve detection of preeclampsia through the measurement of blood pressure at routine prenatal visits.3 In this issue of JAMA, the USPSTF provides a recommendation statement on screening for preeclampsia.4 The current recommendation was based on an updated systematic evidence review by Henderson et al5 conducted on behalf of the task force that evaluated 5 key questions: How effectively does screening for preeclampsia reduce maternal and perinatal morbidity and mortality? What is the effectiveness of risk assessment in early pregnancy for identifying women at high risk for preeclampsia? What are the harms of preeclampsia risk assessment? How effectively do screening tests (eg, blood pressure, proteinuria) identify women with preeclampsia? What are the harms of screening for preeclampsia and do they differ by risk status or screening protocol? Although these questions are all equally important, 3 issues are worthy of discussion: the effectiveness of routine blood pressure measurement for detection of preeclampsia, the evidence of various tests to detect proteinuria, and the value of models to predict preeclampsia before its onset.
