February 8, 2023 – Doctors should screen for hypertensive disorders of pregnancy, which may cause serious and fatal complications for mother and baby, in line with a new recommendation by the US Preventive Services Task Force.
In particular, all pregnant women must have their blood pressure measured at each prenatal visit to assist detect and stop serious health problems. The update expands the duty force's 2017 advice to screen for preeclampsia, or hypertension that may occur while pregnant, to incorporate all hypertensive conditions while pregnant.
“Hypertensive disorders during pregnancy are among the most common causes of serious complications and deaths in pregnant women,” says Esa Davis, MD, task force member and associate professor of drugs and clinical and translational sciences on the University of Pittsburgh School of Medicine.
Screening for these diseases “helps to ensure that Pregnant women and pregnant women of any other sex can be adequately monitored and cared for,” She says.
Hypertensive disorders while pregnant, including gestational hypertension, preeclampsia, eclampsia, and chronic hypertension with and without superimposed preeclampsia, are characterised by increased blood pressure while pregnant.
These disorders can result in complications within the pregnant woman, akin to stroke, retinal detachment, organ damage or failure, and seizures. The baby can even experience growth disorders, low birth weight, and stillbirth. Many complications can even result in early induction of labor, cesarean section, or premature birth.
In the United States, the speed of hypertensive disorders of pregnancy has increased over the past many years, rising from about 500 cases per 10,000 births within the early Nineties to over 1,000 cases per 10,000 births within the mid-2010s.
In updating its 2017 advice, the Task Force made a “Class B” advice for healthcare professionals to supply or perform screening for hypertensive disorders while pregnant, meaning that screening for these disorders using blood pressure measurement has a “substantial net benefit.”
The task force stated that it’s “essential” that each one pregnant women be screened and that ladies who test positive should receive evidence-based treatment for his or her condition.
Risk aspects include a history of eclampsia or preeclampsia, a family history of preeclampsia, a previous antagonistic pregnancy, gestational diabetes or chronic hypertension, pregnancy with multiple child, first pregnancy, high body mass index before pregnancy, and age 35 years or older.
Blacks, American Indians, and Alaska Natives are at higher risk and have a better risk of developing and dying from hypertensive disorder of pregnancy. In particular, blacks have higher rates of maternal and infant morbidity and perinatal mortality than other racial and ethnic groups, and hypertensive disorder of pregnancy is accountable for a bigger proportion of those outcomes.
““Because screening is not enough to address health disparities among Black, American Indian and Alaska Native people, health professionals should also do everything in their power to eliminate these inequalities,” Davis says.
For example, follow-up visits with health care providers such as nurses, midwives, pediatricians and lactation consultants could be helpful, as could screening and monitoring after the baby is born. Other approaches include telemedicine, linking to community resources during the perinatal period, shared care in nursing homes and multi-tiered interventions to address health inequalities that increase health risks during pregnancy.
Although there is currently no treatment for preeclampsia other than delivery, treatment strategies for diagnosed hypertensive disorders of pregnancy include close fetal and maternal monitoring, antihypertensive medications, and magnesium sulfate to prevent seizures. Low-dose aspirin may also be considered in some pregnant women to prevent preeclampsia.
The Task Force identified several gaps for future research, including the best approaches to monitoring blood pressure during pregnancy and the postpartum period, how to address health disparities through multilevel interventions, how to improve access to care through telehealth services, and how to reduce later-life cardiac complications in patients diagnosed with hypertensive disorders in pregnancy.
“More research is required in these promising areas,” says Davis. “We hope all clinicians will join us in helping to be certain that all parents and babies have access to the care they should be as healthy as possible.”
The draft advice statement and Draft evidence review were posted for public comment on the US Preventive Services Task Force website. Comments can be submitted until March sixth.