EXECUTIVE SUMMARY

Cases of preeclampsia in the United States have increased since 1980 from 2.4% of all pregnancies to 3.8% in 2010. This increase is cause for concern: Preeclampsia accounts for more than $2.18 billion of the healthcare expenditure in the first 12 months after birth.

  • Although pregnant women can have other hypertensive conditions along with preeclampsia, the condition is defined as new-onset hypertension (or, in patients with existing hypertension, worsening hypertension) occurring after 20 weeks of gestation, combined with either new-onset excess protein in the urine or other signs or symptoms involving multiple organ systems.
  • Adverse perinatal outcomes for the fetus and newborn may include intrauterine growth restriction, low birth weight, and stillbirth. Several complications associated with the condition lead to early labor induction or cesarean delivery and subsequent preterm birth.

Cases of preeclampsia in the United States have increased since 1980 from 2.4% of all pregnancies to 3.8% in 2010. This increase is cause for concern: Preeclampsia accounts for more than $2.18 billion of the healthcare expenditure in the first 12 months after birth.1

Although pregnant women can have other hypertensive conditions along with preeclampsia, the condition is defined as new-onset hypertension (or, in patients with existing hypertension, worsening hypertension) occurring after 20 weeks of gestation, combined with either new-onset excess protein in the urine or other signs or symptoms involving multiple organ systems.2 Adverse perinatal outcomes for the fetus and newborn may include intrauterine growth restriction, low birth weight, and stillbirth. Several complications associated with the condition lead to early labor induction or cesarean delivery and subsequent preterm birth.2

In a new study published in the American Journal of Obstetrics and Gynecology, researchers used epidemiological and econometric methods to assess the annual cost of preeclampsia in the United States. To conduct their analysis, they used a combination of population-based and administrative data sets, including the National Center for Health Statistics Vital Statistics on Births, the California Perinatal Quality Care Collaborative Databases, the U.S. Health Care Cost and Utilization Project database, and a commercial claims data set.

The data suggest that preeclampsia increased the probability of an adverse event from 4.6% to 10.1% for mothers, and from 7.8% to 15.4% for infants, while reducing gestational age by 1.7 weeks (P < 0.001). The analysis estimated the total cost burden of preeclampsia during the first 12 months after birth at $1.03 billion for mothers and $1.15 billion for infants. The researchers noted that cost burden per infant was dependent on gestational age, ranging from $150,000 at 26 weeks gestational age to $1,311 at 36 weeks gestational age.1

“Rising rates of preeclampsia threaten the health and well-being of mothers and babies,” noted William Callaghan, MD, chief of the Maternal and Infant Health Branch at the Centers for Disease Control and Prevention, in an accompanying editorial.

“Although preeclampsia has affected pregnant women for millennia, there is still much we do not know,” wrote Callaghan. “This new research underscores the urgent need to continue research into its causes and to implement strategies that may help women manage this condition.”

Task Force Examines Evidence

Should clinicians screen for preeclampsia? The U.S. Preventive Services Task Force has just reviewed available evidence on the accuracy of screening and diagnostic tests for preeclampsia. It looked at the potential benefits and harms of screening, the effectiveness of risk prediction tools, and the benefits and harms of treatment of screen-detected preeclampsia. The task force has issued a recommendation for preeclampsia in pregnant women with blood pressure measurements throughout pregnancy.2 The final recommendation applies to pregnant women without a current diagnosis of preeclampsia and with no signs or symptoms of preeclampsia or hypertension.

“If a pregnant woman has high blood pressure during a clinical visit, she should receive further testing and evaluation,” said Task Force chair and Seattle pediatrician David Grossman, MD, MPH, in a press statement. “Several high blood pressure measurements are needed to diagnose preeclampsia.”

Search Is on for Test

Emerging scientific data indicate that preeclampsia is linked with the abnormal presence in the urine of kidney cells known as podocytes.4 Available tests that can identify podocytes are expensive and time-consuming.

Results of a small study, which evaluated 42 pregnant women with preeclampsia and an equal number with normal blood pressure, suggest that a new method of detection can rapidly detect fragments of podocytes in the urine of women with preeclampsia.4 Researchers also found that fetal hemoglobin, normally present in pregnant women’s blood in small amounts, is found in higher amounts in preeclamptic women’s blood.4

“This increased amount of fetal hemoglobin in preeclampsia may be causing the release of podocyte fragments in the urine,” said study co-author Vesna Garovic, MD, a nephrologist at the Mayo Clinic in Rochester, MN, in a press statement. “We hope that this information will result in improved diagnostic procedures in women with preeclampsia; however, additional studies in larger numbers of patients and across different types of preeclampsia are needed.”

REFERENCES

  1. Stevens W, Shih T, Incerti D, et al. Short-term costs of preeclampsia to the United States health care system. Am J Obstet Gynecol 2017; doi.org/10.1016/j.ajog.2017.04.032.
  2. U.S. Preventive Services Task Force. Screening for preeclampsia. U.S. Preventive Services Task Force recommendation statement. JAMA 2017;317:1661-1667.
  3. Li R, Tsigas EZ, Callaghan WM. Health and economic burden of preeclampsia: No time for complacency. Am J Obstet Gynecol 2017; doi: 10.1016/j.ajog.2017.06.011.
  4. Craici IM, Wagner SJ, Weissgerber TL, et al. Advances in the pathophysiology of pre-eclampsia and related podocyte injury. Kidney Int 2014;86:275-285.
  5. Gilani SI, Anderson UD, Jayachandran M, et al. Urinary extracellular vesicles of podocyte origin and renal injury in preeclampsia. J Am Soc Nephrol 2017; doi: 10.1681/ASN.2016111202.