Pre-eclampsia guidelines out of touch with evidence

2 minute read

Latest research shows that the strategies advocated by clinical practice guidelines need to be re-examined.

Not all clinical practice guidelines for pre-eclampsia risk factors align with current evidence, according to new research published in the British Journal of Obstetrics and Gynaecology.

And the findings have led to a call for clinical practice guidelines to be updated to better reflect the current evidence base

UK researchers compared the risk factors identified in guidelines across various countries, including Australia, and found that some of the major and moderate risk factors for pre-eclampsia proposed by eight out of 15 clinical practice guidelines were not well-aligned with evidence.  

Obesity is the only risk factor shown to have a definite association with developing pre-eclampsia based on high-quality evidence. However, none of the guidelines deemed it a major risk factor, and only six endorsed it as a moderate risk factor.

High-quality evidence also supported two other risk factors, maternal overweight and stage 1 hypertension, that weren’t labelled either “major” nor “moderate” in any of the guidelines.

On the other hand, four risk factors that were strongly endorsed by most of the guidelines were only supported by moderate quality evidence: prior pre-eclampsia, chronic hypertension, type 2 diabetes, and fetal trisomy 13.  

Prior hypertensive disorder of pregnancy was labelled a major risk factor for pre-eclampsia in four guidelines; however, the evidence only supported a ‘possible association’ between the two conditions.

In addition, no evidence was found for another 10 of the risk factors featured across the guidelines, including family history of early-onset CVD, gestational hypertension and autoimmune disease.

The findings demonstrate the need for clinical practice guidelines to be updated to reflect the current evidence base, according to the authors.

“While there has been much focus on quality rating scales for guidelines, further improvement is necessary before [clinical practice guidelines] will effectively translate evidence into practice in the field of pregnancy hypertension,” they wrote.

Pre-eclampsia affects around 5-8% of all pregnancies in Australia and complicates 2-4% of pregnancies worldwide.  

Clinical risk factors play a vital role in pre-eclampsia prediction, including risk factors that develop later in pregnancy which require enhanced surveillance and appropriately timed birth.

BJOG 2022, online 9 October

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