Could oedema and proteinuria in pregnancy be used to screen for high risk?: The WHO International Collaborative Study of Hypertensive Disorders of Pregnancy


Summary. Prospectively gathered data from eight geographically defined areas in south-east Asia included serial measures of blood pressure, proteinuria and oedema during pregnancy. A total of 15 476 pregnancies were included. Both antenatal oedema and proteinuria were markers of increased risk of antenatal diastolic hypertension, proteinuric pre-eclampsiaand eclampsia. However they identified fetuses at high risk of low birthweight and perinatal mortality only in areas where the incidence of hypertension was low. As a screeningstrategy to identify women who are at increased risk of antenatal diastolic hypertension, of proteinuric pre-eclampsia and of eclampsia, the most efficient strategy is probably to use the presence of oedema and/or proteinuria. The sensitivity of using this method for identifying women with proteinuric pre-eclampsia is high, but for identifying eclampsia it is still relatively low. Where resources are available there is probably no substitute for using a sphygmomanometer and measuring blood pressure.