Screening

All pregnant women should be seen regularly throughout their pregnancy, and have their blood pressure (BP) measured.[65]​ If hypertension (defined as systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg) is found, and preeclampsia suspected, urinalysis is recommended.[65]​ If high blood pressure persists, there should be a step-up in care to an assessment center or admission to a care facility, depending on findings and symptoms.

Uterine artery Doppler is not recommended as a stand-alone screening tool for predicting the onset of disease.[1][16][54]​​[66]

Screening for preeclampsia by identifying women in the first trimester with risk factors for the disease is advocated by the UK National Institute for Health and Care Excellence.[16] Meta-analyses have shown a 53% risk reduction in pregnant women who are at moderate or high risk for developing preeclampsia who are picked up by screening through prenatal care and offered aspirin prophylaxis from 12 to 16 weeks’ gestation.[67]

Prediction algorithms that use a combination of biomarkers and maternal history have also been evaluated for their potential as first-trimester screening tools for preeclampsia.[68][69] In the ASPRE trial, >26,000 women with singleton pregnancies were screened with an algorithm that combined known maternal risk factors with mean arterial pressure (MAP), the uterine-artery pulsatility index (UTPI), and maternal serum placental growth factor (PlGF) and pregnancy-associated plasma protein A (PAPP-A) taken at 11 to 13 weeks’ gestation.[41] After adjustment for the effect of aspirin, detection rates for preterm and term preeclampsia were 77% and 43%, respectively, with a false-positive rate of 9.2%.[70]

The Federation of Gynecology and Obstetrics (FIGO) recommends that all women should be screened for preterm preeclampsia using a first‐trimester combined test as a one‐step procedure.[20] FIGO suggests that the optimal test includes maternal risk factors and measurements of MAP, serum PlGF, and UPTI. If it is not possible to measure PlGF and/or UTPI, the baseline screening test should be a combination of maternal risk factors with MAP, and not maternal risk factors alone. An algorithm tool derived from these factors, with the option to include serum PAPP-A, is available. The Fetal Medicine Foundation: risk for preeclampsia assessment Opens in new window If resources are limited, FIGO suggests routine screening for preterm preeclampsia by maternal factors and MAP should be performed in all pregnancies.[20]

Although the Food and Drug Administration (FDA) has approved the sFlt-1/PlGF test to aid risk assessment for the progression to preeclampsia with severe features, the American College of Obstetricians and Gynecologists does not recommend any single biomarker test (e.g., PlGF testing or the sFlt-1/PlGF ratio) for the prediction of preeclampsia, diagnosis or exclusion of preeclampsia with severe features, or determination of the management approach after a positive or negative test result.[1][60]

A lack of screening availability may lead to a more acute presentation of preeclampsia, with increased risk of clinical sequelae.

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