University of California, San Francisco.
Kaiser Permanente Washington Health Research Institute, Seattle.
JAMA. 2017 Apr 25;317(16):1661-1667. doi: 10.1001/jama.2017.3439.
Preeclampsia affects approximately 4% of pregnancies in the United States. It is the second leading cause of maternal mortality worldwide and may lead to serious maternal complications, including stroke, eclampsia, and organ failure. Adverse perinatal outcomes for the fetus and newborn include intrauterine growth restriction, low birth weight, and stillbirth. Many of the complications associated with preeclampsia lead to early induction of labor or cesarean delivery and subsequent preterm birth.
Preeclampsia is more prevalent among African American women than among white women. Differences in prevalence may be, in part, due to African American women being disproportionally affected by risk factors for preeclampsia. African American women also have case fatality rates related to preeclampsia 3 times higher than rates among white women. Inequalities in access to adequate prenatal care may contribute to poor outcomes associated with preeclampsia in African American women.
To update the 1996 US Preventive Services Task Force (USPSTF) recommendation on screening for preeclampsia.
The USPSTF reviewed the evidence on the accuracy of screening and diagnostic tests for preeclampsia, the potential benefits and harms of screening for preeclampsia, the effectiveness of risk prediction tools, and the benefits and harms of treatment of screen-detected preeclampsia.
Given the evidence that treatment can reduce maternal and perinatal morbidity and mortality, and the well-established accuracy of blood pressure measurements, the USPSTF found adequate evidence that screening for preeclampsia results in a substantial benefit for the mother and infant. In addition, there is adequate evidence to bound the harms of screening for and treatment of preeclampsia as no greater than small. Therefore, the USPSTF concludes with moderate certainty that there is a substantial net benefit of screening for preeclampsia in pregnant women.
The USPSTF recommends screening for preeclampsia in pregnant women with blood pressure measurements throughout pregnancy. (B recommendation).
子痫前期在美国大约影响 4%的妊娠。它是全球孕产妇死亡的第二大主要原因，可能导致严重的孕产妇并发症，包括中风、子痫和器官衰竭。胎儿和新生儿不良围产期结局包括宫内生长受限、低出生体重和死产。子痫前期相关的许多并发症导致早产引产或剖宫产，继而导致早产。
子痫前期在非裔美国女性中比在白人女性中更为普遍。患病率的差异部分可能归因于非裔美国女性受子痫前期风险因素的影响不成比例。非裔美国女性与子痫前期相关的病死率也比白人女性高 3 倍。获得充分产前保健的不平等可能导致非裔美国女性子痫前期不良结局。
更新 1996 年美国预防服务工作组（USPSTF）关于子痫前期筛查的建议。
USPSTF 回顾了子痫前期筛查和诊断测试的准确性、子痫前期筛查的潜在益处和危害、风险预测工具的有效性以及筛查发现的子痫前期治疗的益处和危害的证据。
鉴于治疗可以降低孕产妇和围产儿发病率和死亡率的证据，以及血压测量已经得到充分证实的准确性，USPSTF 发现有充分证据表明子痫前期筛查对母亲和婴儿有实质性益处。此外，有充分证据表明，筛查和治疗子痫前期的危害不大于小。因此，USPSTF 有中等把握得出结论，对孕妇进行子痫前期筛查有实质性的净获益。
USPSTF 建议在整个孕期通过血压测量对孕妇进行子痫前期筛查。（B 级推荐）。
