In an effort to curb the growing maternal health care crisis, today, the U.S. Preventive Services Task Force (USPSTF) released a simple, but effective recommendation: screen all pregnant individuals for high blood pressure at every routine prenatal visit.
The United States is rife with maternal health crises, especially due to hypertensive disorders, such as preeclampsia, eclampsia, and gestational high blood pressure, a collection of life-threatening conditions that are one of the leading causes of pregnancy-related deaths in the U.S.
In fact, the disorders are present in one-third of maternal deaths during hospital deliveries and directly cause over 6% of all pregnancy-related deaths in the country.
So what exactly does this mean? Anyone pregnant should have their blood pressure levels checked and recorded by their doctor in-office during every appointment throughout pregnancy. This is the recommendation even if you don’t have a history or diagnosis of high blood pressure.
“Because these conditions can cause serious health issues, screening is an important way to keep pregnant people and their babies healthy,” Esa Davis, M.D., M.P.H., a member of USPSTF, said in a statement.
Regular screenings can improve the odds of early detection of serious conditions like preeclampsia, which can cause serious organ damage or when left untreated, can be fatal to the mother and baby.. Pregnant women tend to develop the condition during the second half of pregnancy and the condition can arise in people who have never had high blood pressure previously.
Risk factors for high blood pressure can include gestational diabetes, being pregnant with more than one baby, having a high body mass index, or being 35 or older during pregnancy.
If you develop high blood pressure during pregnancy, doctors will perform multiple tests to confirm the elevated blood pressure readings. The USPSTF recommends a low-dose aspirin as a preventative measure for those at risk of preeclampsia after week 12 of pregnancy.
The final recommendations, published today in JAMA, align with USPSTF’s 2023 draft recommendation on the same subject and are consistent with the 2017 final recommendation to include all hypertensive disorders during pregnancy.
Recommendations to aid in stark racial disparities
While the recommendations are an important step forward, the USPSTF acknowledges it’s not enough. Current maternal mortality rates aren’t “affecting everyone equally,” Dr. Davis tells The Messenger.
She’s talking about the stark racial inequities that plague hypertension-related pregnancy death rates in America.
According to 2019 data, hypertensive disorders affected one in five childbirth hospitalizations in Black birthing women. Moreover, Black people are more likely to experience maternal and infant mortality than any other racial group. Preeclampsia rates are 60 times higher in Black women than in white women, according to the Centers for Disease Control and Prevention (CDC).
Additionally, Native American and Alaska Native pregnant people are also disproportionately affected. Between 2017 and 2019, around 16% were found to have hypertensive disorders during hospital deliveries. However, they account for less than 3% of the U.S. population.
“Disparities are driving a large part of these complications and deaths,” Dr. Davis says. At least part of that problem, Dr. Davis says, results from barriers to access.
Black and indigenous people across the country face several institutional barriers and logistical hurdles to accessing timely pregnancy care. For example, 50% of Black pregnant women in the Boston area were either late or missed prenatal appointments because they had to rely on public transport, according to a 2022 Federal Transit Administration report.
“Being able to just get to a facility” can often be challenging and get in the way of routine hypertension screenings and other necessary routine tests required during pregnancy, Dr. Davis notes.
Among Black people, mistrust of medical experts, often rooted in generations of racism and exploitation, is another plausible cause for the lack of regular prenatal screening, Dr. Davis adds.
“We are using this recommendation to call for more research in this important area and to highlight promising ways to address these inequities and improve the health of those at increased risk,” Wanda Nicholson, M.D., MPH, vice chair of USPSTF, said in a statement.
The risk continues after birth
The final recommendations from the USPSTF also highlight the lack of postpartum hypertension screening. According to a JAMA editorial on the topic, more than half of pregnancy-related deaths occur postpartum. Up to 12% of those deaths could occur 43 days to up to a year after a person gives birth. Postpartum preeclampsia and hypertension have been found to be major contributors.
The general lack of holistic postpartum care for new moms in the U.S. — including an absence of universal paid parental leave — is a well-documented issue. As many as 40% of women currently don’t attend their routine postpartum checkups, according to the American College of Obstetrics and Gynecology.
To add to this, Black and Hispanic people are less likely to go to their follow-up appointments in the six weeks postpartum compared to white people. This is especially concerning as the USPSTF review shows that Black individuals are twice as likely to be diagnosed with postpartum preeclampsia compared to white people.
What’s more, women are often medically cleared at six weeks postpartum, when complications can occur for up to a year after giving birth.
For now, the USPSTF simply advises doctors to “counsel” new mothers on signs of preeclampsia at the time of their hospital discharge — a time which is often the subject of debate and has steadily declined over the past several decades.
Indications for postpartum preeclampsia could include blurry vision, headaches, nausea, pain in the upper belly or the shoulder, trouble breathing and high blood pressure, according to the CDC. Other times, there may not be clear symptoms.
To offset the disproportionate toll on pregnant people of color, Dr. Davis says experts need to explore alternative options “telehealth and remote blood pressure monitoring,” to screen them regularly, especially in the postpartum period.
According to USPSTF, blood pressure monitoring performed by a healthcare practitioner could also help lower the odds of serious complications in the postpartum period.
“We hope that the recommendations will raise awareness to get more people into care earlier,” Dr. Davis says.