Hypertension is a Major Danger in Pregnancy, New Screening Guidelines May Help

Pregnant woman using a blood pressure cuff.
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  • The US Preventative Services Task Force recently updated their guidelines regarding screening for hypertensive disorders among pregnant people.
  • Experts agree that screening is an effective way to improve the detection of hypertensive disorders among pregnant people.
  • Signs of hypertensive disorders of pregnancy include an increase in blood pressure, partial or total loss of vision, nausea or vomiting later in pregnancy, severe upper abdominal pain, and difficulty breathing.

Hypertensive disorders of pregnancy are one of the main causes of pregnancy-related deaths in in the U.S.

To analyze the positive and negative impact of screening for hypertensive disorders of pregnancy, the US. Preventive Services Task Force (USPSTF) conducted a systematic review.

The USPSTF examined pregnant persons without a known diagnosis of a hypertensive disorder or chronic hypertension and found that screening offered significant benefits, as noted in the final recommendation statement.

Specifically, the recommendations include taking blood pressure measurements at each doctor visit during pregnancy. If blood pressure is elevated, repeated measurements should be taken to ensure the accuracy of the reading.

Furthermore, it is crucial that pregnant people who screen positive obtain proper treatment for hypertensive disorders of pregnancy.

Why screening for hypertensive disorders of pregnancy is important

The updated USPSTF Task Force’s recommendation supports the current practice of screening for hypertensive disorders of pregnancy through routine blood pressure measurement at in-person prenatal visits throughout pregnancy.

“Screening is important because early detection may significantly reduce morbidity and mortality for mothers and babies, and improve health outcomes for this population,” Dr. Jennifer Wong, FACOG, Section Chief, Division of Maternal Fetal Medicine, Bridgeport Hospital, told Healthline.

Screening pregnant people for high blood pressure is an essential part of prenatal care. Elevated blood pressure is often one of the first signs that a hypertensive disorder of pregnancy, such as preeclampsia, has developed. 

Preeclampsia is a dangerous condition for pregnant people where blood pressure can spike to dangerous levels. This can lead to eclampsia which can cause seizures and death.

Dr. Annalies Denoble, an Assistant Professor of Obstetrics, Gynecology and Reproductive Sciences at Yale School of Medicine stated, “as a pregnancy care provider, it is reassuring to know that one of the core aspects of routine prenatal care remains one of the most important methods we have for screening for hypertensive disorders of pregnancy.”

Denoble also co-authored an editorial accompanying the new recommendation.

Identifying a hypertensive disorder during pregnancy allows physicians to intervene and reduce the risk of serious complications for both the pregnant person and their unborn infant, Denoble noted. 

What’s causing the rise in maternal mortality rates?

Many experts are calling for more screening due to the rise in maternal mortality rates in the U.S.

“The rise in maternal mortality in the US, particularly among the non-Hispanic black community, is very concerning,” said Wong. “There has been a lot of focus on creating systems to better track these outcomes, and identify causes for maternal mortality, particularly preventable causes.” 

Wong continued: “I think the reason for this rise in mortality is not a single factor, but rather multifactorial. It is impossible to ignore the contribution of racial, ethnic and socioeconomic disparities to this rise, particularly given the 2.6-fold higher mortality among non-Hispanic Black pregnant persons.”

Wong added that younger people are also developing chronic conditions such as type 2 diabetes and high blood pressure at an earlier age.

“The recent pandemic also limited access to routine preventative care for many patients. The rise in maternal mortality likely reflects the combination of these multiple factors,” Wong said.

Warning signs of hypertensive disorders

While there are some symptoms associated with severe features of preeclampsia, most signs are asymptomatic, according to Wong. 

“The first sign of developing hypertensive disorder of pregnancy is an increase in blood pressure. This is why screening focuses on blood pressure evaluations, either in person or by the patients themselves using a home blood pressure cuff,” Wong explained.

Since preeclampsia, and the hypertensive disorders of pregnancy in general, are often asymptomatic, screening is very important. 

“An elevated blood pressure does not always cause symptoms, but can indicate that a hypertensive disorder of pregnancy has developed and that monitoring and treatment is needed,” said Denoble.

When symptoms are present, some of the most concerning symptoms are a severe headache that does not get better with usual treatment like acetaminophen, changes in vision like seeing spots or flashing lights, partial or total loss of vision, new nausea or vomiting later in pregnancy, severe upper right abdominal pain, and difficulty breathing, gasping, or panting.

According to Dr. Angela Burgess, a maternal-fetal medicine physician with UTHealth Houston, the warning signs of hypertensive disorders specifically severe preeclampsia in pregnancy can also include headaches and blurry vision.

Other warning signs can include swelling of the face or hands or weight gain of more than 5 pounds in a week. If any of these symptoms are present, or if blood pressure is over 140/90 in pregnancy, always contact a health care provider.

Addressing the maternal health crisis

The recommendation statement noted the maternal health crisis requires taking action on numerous fronts: national and local governments, communities, health care systems, and individuals and families. 

The ultimate goal is to decrease risk factors for hypertensive disorders of pregnancy and to design effective screening and treatments to keep pregnant people healthy and safe.

“I think that we should start thinking outside of the box,” said Wong. “Given the state of the health crisis, the answer is almost certainly not to continue what we’ve always done. Interventions that increase advocacy and autonomy for patients, patient education about signs and symptoms, removing any obstacles to care, particularly in the postpartum period, and individualizing delivery of care are all interventions that I believe will help address this crisis.”

Denoble explained that the first step is to listen.

“I like to start small by thinking about how I, as an individual obstetric provider, can make a difference. I really appreciate the CDC’s ‘Hear Her’ campaign and believe that we can start making a difference on a small scale by remembering to listen to our patients,” Denoble stated. 

Denoble continued: “Take that moment to truly listen to a pregnant patient, a family member, a friend, to hear their complaint or concern, and you may just save their life. In hindsight, so many cases of maternal death could have been prevented if someone had just stopped, listened, and recognized that the pregnant individual was saying ‘something is not right.’ Our patients know their bodies. Listen to them.

Second, take action. 

“Once we recognize something is abnormal, we have to act,” said Denoble. “As we say in our editorial, ‘Successful screening is only as good as the response to the results.’ Clinicians must continue to implement quality improvement and patient safety bundles that aim to prevent and reduce pregnancy-related complications, such as obstetric hemorrhage and severe hypertension bundles. Continued efforts to educate providers about best practices and provide feedback when best practices aren’t met are an important component to reducing maternal morbidity and mortality.”

Takeaway

According to an updated statement released by the US Preventative Services Task Force, screening for hypertensive disorders is recommended among pregnant people of all genders who have not been previously diagnosed with a hypertensive disorder of pregnancy or chronic hypertension.

Doctors agree that screening is an effective way to improve the detection of hypertensive disorders among pregnant people.

Although most symptoms of hypertensive disorders are asymptomatic, warning signs of hypertension include an increase in blood pressure, partial or total loss of vision, new nausea or vomiting later in pregnancy, severe upper right abdominal pain, and difficulty breathing, gasping, or panting. 

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