Commercial screening tests that purport to predict early-onset preeclampsia may do more harm than good and are not recommended, according to the American College of Obstetricians and Gynecologists.
Early-onset preeclampsia does signal great risk for both mother and infant, and early identification of pregnancies at high risk “would theoretically allow referral for more intensive surveillance or application of preventive therapies to reduce the risk of severe disease.” But the effectiveness of this approach is undercut by the low positive predictive value of currently available tests, according to a new policy statement from ACOG’s Committee on Obstetric Practice published Aug. 19 (Obstet Gynecol 2015;126:e25-7.).
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“These tests require a large number of women to be identified as high risk and to potentially undergo intensive surveillance in order to detect one case of early-onset preeclampsia,” the committee members wrote.
Moreover, there are no data showing that using these screening tests improve clinical outcomes.
Taking a detailed medical history to assess risk factors remains “the best and only recommended screening approach for preeclampsia,” according to ACOG. The medical history should remain the screening method of choice until high-quality evidence demonstrates that aspirin and other interventions reduce the incidence of preeclampsia for women at high risk based on first-trimester predictive tests, ACOG recommended.
“For a first-trimester risk assessment for preeclampsia to be useful in clinical practice, future screening tests will need to have sensitivities and [positive predictive values] high enough to accurately identify women who will develop preeclampsia, and interventions will need to be available that improve clinical outcome in women who test positive,” the committee members wrote.
The new committee opinion has been endorsed by the Society for Maternal-Fetal Medicine.