Feb. 8, 2023 – Doctors should screen for hypertensive disorders of pregnancy, which can cause serious and fatal complications for both the mother and baby, according to a new recommendation from the U.S. Preventive Services Task Force.
In particular, all pregnant people should have their blood pressure measured at each prenatal visit to identify and prevent serious health issues. The update expands on the task force's 2017 recommendation on screening for preeclampsia, or high blood pressure that can occur during pregnancy, to include all hypertensive disorders of pregnancy.
"Hypertensive disorders of pregnancy are some of the leading causes of serious complications and death for pregnant people," says Esa Davis, MD, a task force member and associate professor of medicine and clinical and translational science at the University of Pittsburgh School of Medicine.
Screening for these disorders, "helps ensure that pregnant women and pregnant people of all other genders can be monitored and cared for appropriately," she says.
Hypertensive disorders of pregnancy, including gestational hypertension, preeclampsia, eclampsia, and chronic hypertension with and without superimposed preeclampsia, are marked by elevated blood pressure during pregnancy.
These disorders can lead to complications for the pregnant person, such as stroke, retinal detachment, organ damage or failure, and seizures, as well as the baby having restricted growth, low birth weight, and stillbirth. Many complications can also lead to early induction of labor, a C-section, and preterm birth.
In the U.S., the rate of hypertensive disorders of pregnancy has increased in recent decades, jumping from about 500 cases per 10,000 deliveries in the early 1990s to more than 1,000 cases per 10,000 deliveries in the mid-2010s.
Updating its 2017 recommendation, the task force provided a "grade B" recommendation for health care professionals to offer or provide screening for hypertensive disorders of pregnancy, meaning that screening for these disorders with blood pressure measurements has "substantial net benefit."
The task force noted that it is "essential" for all pregnant people to be screened, and those who screen positive should receive evidence-based management for their condition.
Risk factors include a history of eclampsia or preeclampsia, a family history of preeclampsia, a previous adverse pregnancy outcome, having gestational diabetes or chronic hypertension, being pregnant with more than one baby, having a first pregnancy, having a high body mass index prior to pregnancy, and being 35 years or older.
Black, American Indian, and Alaska Native people face higher risks and are more likely to both have and die from a hypertensive disorder of pregnancy. In particular, Black people have higher rates of maternal and infant morbidity and perinatal mortality than other racial and ethnic groups, and hypertensive disorders of pregnancy account for a larger proportion of these outcomes.
"Since screening is not enough to address the health disparities experienced by Black, American Indian, and Alaska Native people, health care professionals should also do what they can to help address these inequities," Davis says.
For instance, follow-up visits with health care providers such as nurses, nurse midwives, pediatricians, and lactation consultants could help, as well as screening and monitoring after the baby is born. Other approaches include telehealth, connections to community resources during the perinatal period, collaborative care provided in medical homes, and multilevel interventions to address health inequities that increase health risks during pregnancy.
Although there is no currently available treatment for preeclampsia except delivery, management strategies for diagnosed hypertensive disorders of pregnancy include close fetal and maternal monitoring, anti-hypertension medications, and magnesium sulfate for seizure prevention. Some pregnant people should also be considered for low-dose aspirin to prevent preeclampsia.
The task force noted several gaps for future research, including the best approaches for blood pressure monitoring during pregnancy and the postpartum period, how to address health inequities through multilevel interventions, how to increase access to care through telehealth services, and how to lessen heart-related complications later in life in patients diagnosed with hypertensive disorders of pregnancy.
"Continued research is needed in these promising areas," Davis says. "We hope all clinicians will join us in helping ensure that all parents and babies have access to the care they need to be as healthy as possible."
The draft recommendation statement and draft evidence review were posted for public comment on the U.S. Preventive Services Task Force website. Comments can be submitted until March 6.
