Systematic Review: Do the Preeclampsia Risk Factors in Clinical Practice Guidelines Align with Evidence?
BACKGROUND AND PURPOSE:
Elawad et al. (BJOG, 2022) compare pre-eclampsia risk factors identified by clinical practice guidelines (CPGs) with risk factors from hierarchical evidence review, to guide the prevention of preeclampsia
Systematic review of CPGs and evidence review for preeclampsia risk factors
CPGs published in English, French, Dutch or German
Covers diagnosis, assessment and management of hypertensive disorder of pregnancy (HDP)
Evidence of preeclampsia risk factors were assessed using a hierarchical review (umbrella reviews, followed by systematic reviews, and large observational studies)
Strength of association and quality of evidence was assessed with GRADE criteria
15 CPGs | 78 preeclampsia risk factors
Preeclampsia risk factors that arise only during pregnancy: 16.5% (13 factors)
Quality of evidence to support a risk factor’s link with preeclampsia was usually low
The ‘major’ and ‘moderate’ risk factors proposed by 8 of the 15 CPGs were not well-aligned with evidence
Obesity (6/14 ‘moderate’)
Moderate quality evidence
Prior preeclampsia (4/10 ‘major’)
Chronic hypertension (8/13 ‘major’)
Type 2 diabetes (8/14 CPGs major’)
Trisomy 13 (1 CPG)
Adolescence (1 CPG)
Type 1 diabetes (8/14 ‘major’)
Severe anemia (not endorsed)
High quality evidence
Overweight (2 CPGs)
Stage 1 hypertension (3 CPGs)
Prehypertension (not endorsed)
Antiphospholipid antibody syndrome (8/12 ‘major’)
Family history of preeclampsia in mother or sister (1/5 ‘major’ | 3/5 ‘moderate’)
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