NICE Guidance on Routine Blood Testing for Pre-eclampsia

Pre-eclampsia is a potentially dangerous condition suffered only by pregnant women. It occurs in the second half of pregnancy and after childbirth.

There are numerous risks associated with the complications of pre-eclampsia in pregnancy including HELLP syndrome, eclampsia, fetal growth restriction, stillbirth, preterm birth and injuries to the mother including damage to the liver, kidneys brain and lungs.

NICE approves routine blood testing for diagnosis of pre-eclampsia

Up until recently, the routine healthcare given to pregnant women did not include testing to detect suspected preterm pre-eclampsia, it could only be used to rule out pre-eclampsia. However, recent guidance has been issued by the National Institute for Health and Care Excellence (NICE) which has approved four tests for routine use.

This milestone in maternal care means that midwives and pregnancy healthcare teams can now use the tests during routine examinations in order to help make the best decisions for the care of women in higher risk groups and those presenting with early symptoms of preterm pre-eclampsia.

Early symptoms of pre-eclampsia

High blood pressure (hypertension) and having protein in the urine are two of the early symptoms of preterm pre-eclampsia. The new antenatal care guidelines recommend taking blood pressure readings and checking for protein in the urine should be done at every antenatal visit to help spot those at risk of developing pre-eclampsia.

The newly recommended pre-eclampsia blood tests, which can be used from week 20 to week 36 and six days, measure levels of placental growth factor (PLGF), a protein which contributes to the development of blood vessels in the placenta. Low levels of PLGF can be an indicator of abnormal placental development.

Helping practitioners make better pregnancy healthcare decisions

In its guidance, NICE said, “PLGF-based tests are likely to substantially benefit women with suspected preterm pre-eclampsia.”

Professor Jenny Myers, clinical professor at Manchester Maternal & Fetal Health Research Centre called for the tests to be available in every hospital across the UK. She said, “We now have the evidence to show that PLGF-based testing can help rule in pre-eclampsia, as well as rule it out.

“As clinicians, this will help ensure those with pre-eclampsia are on the right surveillance path, and those without pre-eclampsia can safely go home.”

More research is needed

NICE has stated that more research is necessary and specifically referenced two areas:

• Testing of women who are pregnant with more than one baby
• Repeat testing

The current research findings have not produced enough evidence to support the efficacy of the tests on women carrying multiple babies and whether repeat testing improves outcomes. The current guidelines say the new tests should only be carried out once.