However, the committee were also aware of further results from a large, UK-based study, which provided further evidence for the efficacy of a threshold of 8 mg/mmol in the diagnosis of severe pre-eclampsia. The committee were aware that this threshold is different to that used for detection of microalbuminuria in the non-pregnant population. However, they agreed that, on the basis of the evidence reviewed, it was appropriate to use a threshold of 8 mg/mmol for pregnant women. As with PCR, the committee were aware that women are sometimes diagnosed with pre- eclampsia on the basis of a single raised ACR, and that this may lead to over-diagnosis. Therefore they made a recommendation to consider repeating the ACR measurement if there was ongoing clinical uncertainty about the diagnosis. No evidence was reviewed that examined the timing of repeat testing for either ACR or PCR, and so no recommendations could be made regarding this. How the recommendations might affect practice The recommendation to take account of other clinical features when assessing women for suspected pre-eclampsia might lead to an increased need for follow-up and surveillance. However, this will also reduce the chance that a diagnosis of pre-eclampsia is missed by raising awareness of the multi-system nature of the disease, and so could reduce the number of women who go on to develop complications from undiagnosed pre-eclampsia. Not all secondary care units currently use automated dipstick analysis to screen for proteinuria, so the recommendations might increase the need for automated reagent-strip reading devices. However, the accuracy and reliability of screening will be improved, reducing the need for further investigations for some women and correctly identifying more women who need further testing or investigations. 