The current guidelines used by clinicians to assess the risk of preeclampsia in pregnant women may not be as effective as previously thought, according to a recent study published in JAMA Network Open. These guidelines, developed by the U.S. Preventive Services Task Force (USPSTF), categorize patients into high-, moderate-, and low-risk groups and recommend low-dose aspirin as a preventative measure for those at risk. However, the study found that the guidelines lead to a high rate of false positives, with a large proportion of patients being classified as at risk but not actually developing the condition.
Preeclampsia is a serious condition that can lead to high blood pressure, organ damage, and even maternal and fetal death. It affects about 4% of all pregnancies in the U.S. and disproportionately impacts non-Hispanic Black women. The current guidelines recommend low-dose aspirin for patients with certain risk factors, such as a history of preeclampsia or pregestational diabetes. However, the study found that these risk factors do not always accurately predict the development of preeclampsia.
The researchers conducted an observational cohort study involving over 5,600 patients with singleton pregnancies at 11 academic medical centers across the country. They found that the guidelines classified 89% of the study population as at risk for preeclampsia, with over 70% at moderate risk. However, only a small percentage of these patients actually went on to develop the condition. Additionally, the study found that the association of moderate risk factors with preeclampsia was inconsistent, suggesting that these factors may not necessarily indicate a higher risk of the condition.
One of the key findings of the study was that maternal race, a moderate risk factor according to the guidelines, was not correlated with preeclampsia. This challenges existing clinical practices and suggests that structural inequities, rather than race itself, may underlie the condition. The study also found that aspirin is under-prescribed in patients classified as being at moderate risk, indicating that the guidelines may not provide adequate guidance for aspirin use among these patients.
Overall, the study highlights the need for better guidelines for preeclampsia screening and treatment. The current approach to diagnosing and treating preeclampsia has remained largely unchanged for decades, and there is a growing recognition of the need for more personalized and effective risk assessment tools. By improving the accuracy of risk assessment and treatment guidance, clinicians can provide better care for pregnant women at risk of developing preeclampsia.
