IN THE NEWS: New guidelines for Hypertension in Pregnancy

A recent task force from ACOG ( included high risk OB, anesthesiologists, nephrologists) in 2013 re-evaluated the definition and concept of using proteinuria in the diagnosis of pre-eclampsia. Proteinuria is not going to be considered a hard finding anymore for the diagnosis of pre-eclampsia. The ACOG felt that this would delay diagnosis in many cases. The entire report is found here.
Proteinuria seemed to have been down graded in many instances in the report. 

Diagnosis:

BP criteria remained
Proteinuria over 5gm has been eliminated from the term of severe preclampsia.
Severe features of pre-eclampsia now include: BP changes, SBP>160mmHg, low platelets, impaired liver function, AKI, pul edema and new onset cerebral disturbances.

Some other changes:

• Screening to predict preeclampsia beyond taking an appropriate medical history to evaluate for risk factors is not recommended.
• Vitamin C or vitamin E to prevent preeclampsia is not recommended.
• Daily low-dose aspirin to help prevent preeclampsia is suggested in very high-risk women with a history of preeclampsia and preterm delivery.
• Antihypertensive medication is recommended for severe hypertension during pregnancy.
• A decision to deliver should not be based on the amount of proteinuria or change in the amount of proteinuria.
• The use of magnesium sulfate is recommended for severe preeclampsia, eclampsia, or HELLP syndrome.

Risk factors the task force came up with for pre-eclampsia:

Primiparity

Prior pre eclampsia

CKD

Chronic HTN

Thrombophilia history

Multi-fetal pregnancy

IVF

Family history

DM I or II

Obesity

SLE

Advanced maternal age ( >40)