OB/GYNs Say High Urine Protein No Longer Necessary for Preeclampsia Diagnosis

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December 20, 2013

The American College of Obstetricians and Gynecologists (ACOG) recently issued a report by its Task Force on Hypertension in Pregnancy that recommends changes to the way preeclampsia is diagnosed.

Preeclampsia is a severe form of high blood pressure (hypertension) that can occur during pregnancy, typically after the 20th week. If the condition is left untreated, it can lead to serious, potentially fatal health problems for a mother and her baby, including development of eclampsia (life-threatening seizures) in the mother. To avoid serious complications, treatment often involves early delivery, either by performing a Cesarean section or inducing labor.

Traditionally, diagnosis of preeclampsia has been made on the basis of two signs in the mother: high blood pressure and elevated protein in the urine (proteinuria). But now the ACOG Task Force is recommending that the presence of high levels of protein in a pregnant woman's urine (see Urine Protein) no longer be a requirement for diagnosis.

Instead, the Task Force recommends that health practitioners take into consideration other factors. Specifically, if proteinuria is not present, diagnosis of preeclampsia should be based on blood pressure values and the presence of one or more signs that include: a low platelet count (thrombocytopenia), livery injury (high blood levels of liver enzymes), progressive kidney insufficiency (high blood creatinine), fluid accumulation in the lungs (pulmonary edema), and/or development of cerebral or visual disturbances (i.e., severe headache, dizziness, flashing lights, blurry vision, sensitivity to light). 

Many women with preeclampsia have no symptoms, and symptoms that may be present are nonspecific, making diagnosis a challenge. When present, symptoms can include nausea, vomiting, abdominal pain, and swelling of the hands, feet, and face. The experts in the ACOG Task Force raised concern that relying on the presence of proteinuria could hamper timely diagnosis and treatment of preeclampsia in some women.

"The problem is that many patients with preeclampsia don't have enough proteinuria to meet the former criteria, so their diagnosis and treatment is delayed" said Dr. James Martin, Jr, past president of ACOG and vice chair for research and academic development and chief of the division of maternal-fetal medicine at the University of Mississippi Medical Center, in the ACOG news release on the Task Force report. Nevertheless, it remains to be seen how these new recommendations might be implemented or how they will impact clinical practice.

The cause of preeclampsia is unknown, but certain factors increase a woman's risk, including age (35 or older), having chronic high blood pressure, diabetes, or kidney disease, being obese, being African American, and having had preeclampsia during a previous pregnancy.

Early identification of women who are likely to develop preeclampsia would be a desired improvement over diagnosis of the condition once it has developed. Although the Task Force's report acknowledges that several potential biomarkers have shown promise in the research stages of development, it concludes that at this time there are no screening tests that can reliably predict whether a woman will develop preeclampsia. Until more clinical trials have been performed to verify the usefulness of these markers, screening to predict preeclampsia should be limited to taking a medical history to assess risk factors.

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NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used.

ACOG Task Force on Hypertenion in Pregnancy. 2013 Available online at http://www.acog.org/Resources_And_Publications/Task_Force_and_Work_Group_Reports/Hypertension_in_Pregnancy through http://www.acog.org. Accessed November 2013.

ACOG news release: Ob-Gyns Issue Task Force Report on Hypertension in Pregnancy. Available online at http://www.acog.org/About_ACOG/News_Room/News_Releases/2013/Ob-Gyns_Issue_Task_Force_Report_on_Hypertension_in_Pregnancy through http://www.acog.org. Accessed November 2013.

MayoClinic.com. Preeclampsia. Available online at http://www.mayoclinic.com/health/preeclampsia/DS00583 through http://www.mayoclinic.com. Accessed November 2013.

March of Dimes. Preeclampsia. Available online at http://www.marchofdimes.com/pregnancy/preeclampsia.aspx through http://www.marchofdimes.com. Accessed November 2013.