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

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-eclampsia and 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 screening strategy 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.