Healthcare providers should screen for hypertensive disorders in pregnancy (HDPs) with blood pressure measurements throughout pregnancy, according to a final recommendation released by the U.S. Preventive Services Task Force (USPSTF) on Sept. 19.
The recommendation states that blood pressure measurements should be obtained during every prenatal visit, noting that HDPs “can quickly evolve into severe disease that can result in serious, even fatal, maternal and infant health outcomes.”
HDPs include chronic hypertension (also known in this context as pre-pregnancy hypertension); gestational hypertension (hypertension that develops during pregnancy); preeclampsia (sudden development of high blood pressure and protein in the urine and possibly other problems after 20 weeks of pregnancy; eclampsia (preeclampsia with seizures); and hemolysis, elevated liver enzymes, and low platelet count, also known as HELLP syndrome (a life-threatening condition that can occur during pregnancy or after delivery).
HDPs are one of the leading causes of maternal morbidity and mortality in the U.S. From 2017 to 2019, HDP prevalence in delivery-related hospitalizations increased from 13.5% to 15.9%, according to a study published by the Centers for Disease Control and Prevention. The study also showed that HDP prevalence was highest among Black women (20.9%) and Native American or Alaskan women (16.4%) during the same period. A study published in the Journal of the American Medical Association estimated the prevalence of HDP in Arkansas to be 5.45% in 2017.
Risk factors for HDP include nulliparity (no previous births), advanced age, obesity, twin pregnancy, and diabetes. Lifestyle and behavioral interventions, including an optimal diet and appropriate maternal weight gain along with exercise, can improve pregnancy outcomes. A low-dose aspirin regimen initiated between the 12th and 16th week of pregnancy can also reduce the risk of preeclampsia among pregnant women who are at high risk.
The USPSTF gave the recommendation a “B” grade, meaning the panel recommends the service and there is high certainty of a moderate net benefit or there is moderate certainty that the net benefit is moderate to substantial. Recommendation grades range from A (highest certainty of substantial benefit) to D (moderate or high certainty of no net benefit, or of the harms outweighing the benefits; the USPSTF discourages the use of services with this grade). Under the Affordable Care Act’s definition of covered preventive services, certain health plans are required to provide coverage for services with a grade of A or B.
The USPSTF is an independent, voluntary panel of national health experts in disease prevention and evidence-based medicine. Every recommendations from the USPSTF is based on a review of high-quality scientific evidence; the goal is not only to offer guidance to healthcare providers but also to provide patients and their families with accurate and up-to-date information.
HDPs represent just one of the many potential hurdles encountered in the birthing journey, leading to poor maternal and infant health outcomes for many. The maternal mortality rate in the U.S. far exceeds the rates in all other economically developed peer nations, with rates among Black women in the U.S. more than double the rate for all women globally. Unfortunately, Arkansas has the highest maternal mortality rate and the third-highest infant mortality rate in the U.S.
For more on health risks related to the birthing journey, and ways the risks could be reduced, see our Maternal and Infant Health page.