Evaluating the Effectiveness of Guidelines for Predicting Preeclampsia Risk

Overview of the Study
A recent study led by Dr. Thomas McElrath from Brigham & Women's Hospital investigated how well current guidelines identify women at risk for preeclampsia (PE), a hypertensive pregnancy disorder affecting 7-10% of pregnancies. Despite advances in understanding PE's causes, predicting its occurrence remains challenging due to its complex and varied presentation.

Assessing Risk Prediction Guidelines
The United States Preventive Services Task Force (USPSTF) developed a set of risk factors based on previous studies to help clinicians evaluate patient risk. However, these factors originated from separate studies and were not tested collectively within a diverse population. The study aimed to determine how effectively these guidelines classify women at risk and whether at-risk women are receiving preventive interventions like low-dose aspirin.

Methodology
The research included over 5,600 women with singleton pregnancies from 11 geographically diverse U.S. centers. Women were categorized into high, moderate, or low risk based on the presence of specific risk factors identified by the USPSTF. High risk included at least one high-risk factor; moderate risk involved at least one moderate risk factor without high-risk factors; low risk meant no risk factors were present.

Key Findings
The study revealed that 18% of participants were high risk, 71% were moderate risk, and 11% were low risk, meaning 89% of women were classified as moderate or high risk. Interestingly, the actual incidence of PE was 0% in the low-risk group, 5% in the moderate-risk group, and 5% in the high-risk group.

While most women (82%) identified as high risk received recommendations for aspirin prophylaxis, only about half of the moderate-risk women did so. Specifically, less than 25% of women with a single moderate risk factor and about half of those with multiple moderate risk factors were prescribed aspirin, highlighting a gap between risk identification and preventive treatment.

Implications and Future Directions
The findings suggest that current guidelines tend to classify a large proportion of pregnant women as at risk for PE, which may limit their utility in focusing clinical resources on those most in need. The authors recommend that risk factors for PE and other conditions should be evaluated together in a single, comprehensive analysis, rather than aggregated from separate studies, to improve risk stratification and clinical decision-making.

Conclusion
This research underscores the importance of validating and refining risk assessment tools to ensure they effectively guide preventive strategies like aspirin use, ultimately aiming to reduce the incidence and impact of preeclampsia in pregnancy.

Source: https://medicalxpress.com/news/2025-07-qa-effectiveness-guidelines-preeclampsia.html