Everyone who is pregnant should be screened for disorders such as gestational hypertension and preeclampsia with blood pressure monitoring throughout the pregnancy, the US Preventive Services Task Force recommended Tuesday.
The recommendation, published in the medical journal JAMA, is for all pregnant people and particularly those without a “known diagnosis of a hypertensive disorder of pregnancy or chronic hypertension.”
Hypertensive disorders of pregnancy often include chronic hypertension and gestational hypertension as well as preeclampsia and eclampsia, according to the USPSTF, a group of independent volunteer medical experts whose recommendations help guide doctors’ decisions.
The recommendation urges doctors to monitor blood pressure during pregnancy as a screening tool for all disorders related to high blood pressure, particularly preeclampsia, a serious condition that typically develops after 20 weeks of pregnancy and more often in the third trimester, according to the American College of Obstetricians and Gynecologists.
Preeclampsia can affect all the organs in the body and can sometimes lead to a condition that causes seizures and stroke.
“We are currently in the midst of a maternal health crisis in the US,” said Dr. Esa Davis, a member of the task force and senior associate dean for population health and community medicine at the University of Maryland in Baltimore.
“We have the highest rates of maternal deaths and very high rates of complications that are occurring during and shortly after pregnancy,” she said. “A leading cause of those deaths and complications are this group of hypertensive disorders of pregnancy.”
It’s already standard practice for blood pressure measurements to be taken during every prenatal visit, but Davis said the official recommendation gives health practitioners a definable treatment plan. Going forward, pregnant people might notice their doctor paying closer attention to their blood pressure during routine visits.
“The difference is now really highlighting the importance of that – that this is a single approach that is very effective,” she said.
The task force’s hope is that extra monitoring may reduce the risk that some hypertensive disorders among moms-to-be go undiagnosed or untreated. Taking a pregnant person’s blood pressure at every prenatal visit is a the “optimal tool” in identifying and preventing these disorders, she says.
The task force came to this conclusion after reviewing data on different ways to screen for hypertensive disorders of pregnancy from studies published between January 2014 and January 2022.
“In addition to risks of mortality to pregnant individuals, hypertensive disorders of pregnancy contribute to pregnancy-related morbidity and risks to the fetus, including fetal growth restriction and indicated preterm delivery,” the Evidence-Based Practice Center wrote in the evidence review.
Who’s at risk for hypertensive disorders? Hypertensive disorders in pregnancy can be deadly, and they are on the rise in the United States.
Between 2017 and 2019, their prevalence among hospital deliveries increased from 13.3% to 15.9%, affecting at least 1 in 7 deliveries in the hospital during that period, according to data published last year by the US Centers for Disease Control and Prevention.
Among deaths during delivery in the hospital, about 1 in 3 (31%) had a documented diagnosis code for hypertensive disorder during pregnancy.
Older women, Black women and American Indian and Alaska Native women were at higher risk of hypertensive disorders, the data shows. These disorders were documented in about 1 in 3 delivery hospitalizations among women ages 45 to 55.
The prevalence of hypertensive disorders in pregnancy was 21% among Black women, 16% among American Indian and Alaska Native women, 15% among White women, 13% among Hispanic women and 9% among Asian or Pacific Islander women.
Communities of color are at the highest risk for hypertensive disorders during pregnancy, Dr. Ilan Shapiro, chief health correspondent and medical affairs officer for AltaMed Health Services, a federally qualified community health center in California, previously told CNN. He was not involved with the task force or its recommendation.
“It’s very related to social determinants of health and access to care,” he said.
The social determinants of health refer to the conditions and environments in which people live that can have a significant effect on their access to care, such as income, housing, safety and not living near sources for healthy food or easy transportation. They “make a huge difference for the mother and baby,” according to Shapiro.
Eating healthy foods and getting regular exercise also can help get high blood pressure under control, and some blood pressure medications are considered safe to use during pregnancy, but patients should consult with their doctor.
Postpartum care.The task force did not make a recommendation on monitoring blood pressure after pregnancy.
“We currently do not have the level of evidence that would be needed to make a recommendation for or against screening for blood pressure in the postpartum period,” Davis said.
A 2019 review of nine observational studies on postpartum monitoring of hypertensive disorders of pregnancy and gestational diabetes shows a pattern of lower rates of follow-up for Black and Hispanic people than White people in the six weeks after delivery.
The evidence review of the recommendation suggests that patients be given guidance on identifying the signs and symptoms of hypertensive disorders of pregnancy upon discharge from the hospital. Patients should reach out to their doctor if they have a headache, blurred vision, shortness of breath or swelling of the legs, Davis said, adding that patients can also monitor their blood pressure at home after giving birth.
“If a patient has a blood pressure monitoring cuff and is able to check their blood pressure, or able to get their blood pressure checked at a pharmacy and then they see that it is not normal, certainly follow up with their physician,” Davis said.
