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Ob-Gyns Issue Task Force Report on Hypertension in Pregnancy

Preeclampsia Diagnosis No Longer Requires Presence of Proteinuria

November 14, 2013

Washington, DC -- The diagnosis of preeclampsia, a leading cause of maternal mortality in the US and worldwide, no longer requires the detection of high levels of protein in the urine (proteinuria), according to the new Task Force Report on Hypertension in Pregnancy by The American College of Obstetricians and Gynecologists (The College). The Task Force recommends that physicians also consider other factors, in addition to elevated blood pressure, to make the diagnosis of preeclampsia. 

image“This Task Force report changes the paradigm that we use in diagnosing preeclampsia from one that is dependent on new onset hypertension and proteinuria,” said James N. Martin, Jr, MD, past president of The College and vice chair for research and academic development and chief of the division of maternal-fetal medicine at the University of Mississippi Medical Center in Jackson, MS. “The problem is that many patients with preeclampsia don’t have enough proteinuria to meet the former criteria, so their diagnosis and treatment is delayed.”

The rate of preeclampsia in the US has increased 25% in the last two decades and is a leading cause of maternal and infant illness and death. Preeclampsia is a serious condition that typically starts after the 20th week of pregnancy; high blood pressure is a main contributing factor. Women who have chronic hypertension, have had preeclampsia in a previous pregnancy, are 35 or older, are carrying more than one fetus, have diabetes or kidney disease, are obese, are African American, or have certain immune disorders are at increased risk of developing preeclampsia.

Signs of preeclampsia include severe headaches, changes in vision, rapid weight gain, abdominal pain, and swelling (edema) of the hands and feet. The cure for preeclampsia begins with delivery of the baby.

“Preeclampsia affects so many women (about 5% of pregnant women) and has so many potentially dangerous outcomes, including preterm delivery, severe hypertension, stroke, and seizures—even death of the mother in the worst-case scenario. Detecting it early and treating it well is a major global health need,” Dr. Martin said.

According to the Task Force, preeclampsia is associated with future cardiovascular and metabolic disease in women. imageWomen with a history of preeclampsia have a 1.5 to 2 times higher risk of developing heart disease later in life. Although preeclampsia does not cause heart disease, both share common risk factors.

Women who had hypertension or preeclampsia in a prior pregnancy have a higher than normal risk of developing it again in a subsequent pregnancy. “Depending on what stage of pregnancy it occurred in and whether a woman is obese or has diabetes, kidney disease, or other forms of vascular disease, the risk of a recurrence can be as high as 50%,” Dr. Martin said. The Task Force found no evidence of any effective interventions to prevent preeclampsia. At this time, there is no screening test to reliably predict if a woman will develop preeclampsia.

The Task Force Report on Hypertension in Pregnancy includes recommendations for managing and treating preeclampsia, chronic hypertension and superimposed preeclampsia, and later-life heart disease in women with a history of preeclampsia.  

Among some of the evidence-based recommendations:

  • Screening to predict preeclampsia beyond taking an appropriate medical history to evaluate for risk factors is not recommended.
  • Vitamin C or vitamin E to prevent preeclampsia is not recommended.
  • Daily low-dose aspirin to help prevent preeclampsia is suggested in very high-risk women with a history of preeclampsia and preterm delivery.
  • Antihypertensive medication is recommended for severe hypertension during pregnancy.
  • A decision to deliver should not be based on the amount of proteinuria or change in the amount of proteinuria.
  • The use of magnesium sulfate is recommended for severe preeclampsia, eclampsia, or HELLP syndrome.

About the Task Force

Dr. Martin created the Task Force in 2011 as part of his ACOG presidential initiative that focused on preeclampsia and hypertension in pregnancy. The Task Force was chaired by James M. Roberts, MD, of the University of Pittsburgh, and included 17 internationally recognized experts on hypertensive disorders in pregnancy who reviewed data and then developed evidence-based clinical practice recommendations. The final report clarifies the classification system for hypertensive disorders in pregnancy, identifies issues in the management of preeclampsia, eclampsia, and chronic hypertension in pregnancy that deserve special attention, and highlights its potential impacts later in life.

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Resources:

The Task Force Report on Hypertension in Pregnancy is available here.

See Committee Opinion #514, “Emergent Therapy for Acute-Onset, Severe Hypertension With Preeclampsia or Eclampsia.”  

James N. Martin, Jr, MD, discusses preeclampsia in a YouTube video.

See ACOG’s FAQ “High Blood Pressure in Pregnancy” for patients.

Visit The Preeclampsia Foundation.  

The American College of Obstetricians and Gynecologists (The College), a 501(c)(3) organization, is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of approximately 57,000 members, The College strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care. The American Congress of Obstetricians and Gynecologists (ACOG), a 501(c)(6) organization, is its companion organization. www.acog.org

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