Final Research Plan
Screening for Hypertensive Disorders of Pregnancy
September 02, 2021
Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
- How effective are different screening programs used to identify hypertensive disorders of pregnancy for reducing maternal and perinatal morbidity and mortality?
- How effective are different screening programs for identifying persons with hypertensive disorders of pregnancy?
- What are the harms of different screening programs used to identify hypertensive disorders of pregnancy?
Contextual questions will not be systematically reviewed and are not shown in the Analytic Framework.
- How do racism and social inequalities contribute to existing inequities in morbidity and mortality from hypertensive disorders of pregnancy? For example, what accounts for higher mortality from hypertensive disorders of pregnancy among Black compared with White populations in the United States?
- Are there effective interventions that could redress existing inequities in morbidity and mortality from hypertensive disorders of pregnancy?
- What is the effectiveness of blood pressure self-monitoring and its potential utility in telehealth prenatal or postpartum care delivery?
- How are risk assessment and risk prediction tools being used in clinical practice to inform screening programs?
The Research Approach identifies the study characteristics and criteria that the Evidence-based Practice Center will use to search for publications and to determine whether identified studies should be included or excluded from the Evidence Review. Criteria are overarching as well as specific to each of the key questions (KQs).
|Category||Inclusion criteria||Exclusion criteria|
|Populations||Pregnant and postpartum persons, including those at increased risk for hypertensive disorders of pregnancy||Studies limited to:
|Interventions||Screening programs used to identify preeclampsia and other hypertensive disorders of pregnancy over the course of pregnancy and in the postpartum period (up to 8 weeks after delivery), including studies comparing screening with different protocols in terms of:
Programs for monitoring persons with hypertensive disorders of pregnancy
|Comparisons||Usual care screening programs, as defined by the study|
|Outcomes||KQ1 (maternal and perinatal health outcomes):
KQ 2 (hypertensive disorders of pregnancy):
KQ 3 (harms):
|Nonclinical health outcomes, such as length of hospital stay (without indication), intensive care unit admission, or neonatal intensive care unit admission|
|Setting||Primary care outpatient settings for obstetric care (e.g., obstetrician-gynecologists, family physicians, certified nurse midwives)
Countries categorized as “Very High” or equivalent on the Human Development Index (as defined by the United Nations Development Programme)
|Clinics and study sites treating only high-risk maternity patients|
|Study Designs||Randomized, controlled trials; controlled clinical trials; and nonrandomized studies comparing screening programs (e.g., comparisons over time or between settings, population cohort studies, nested case-control studies)||Studies that do not represent the spectrum of disease (e.g., case-control study, editorial, narrative review, commentary, postmarketing surveillance, and case report)|
|Publication Dates||References from the previous USPSTF review, and eligible studies identified through a bridge search|
|Study Quality||Good and fair quality according to USPSTF design-specific criteria||Poor quality according to USPSTF design-specific criteria|
|Publication language||English||Non-English language studies|
The draft Research Plan was posted on the USPSTF website for public comment from May 20, 2021, through June 16, 2021. The USPSTF received comments and questions related to the scope of the review. In response, the USPSTF modified the Research Plan to clarify the population of interest, the wording of the contextual questions, and the focus of the review on the health effects of screening in the prenatal and postpartum periods.