Knowledge | U.S. Experts Recommend Blood Pressure Checks at Every Prenatal Visit to Prevent Hypertensive Complications
The U.S. Preventive Services Task Force (USPSTF) has recommended blood pressure monitoring at every prenatal visit for all pregnant patients to screen for hypertensive disorders of pregnancy. This update expands its 2017 preeclampsia screening recommendation to cover all pregnancy-related hypertensive disorders.
“Hypertensive disorders of pregnancy are among the leading causes of severe maternal complications and death,” said task force member Dr. Esa Davis, associate professor of medicine and clinical and translational science at the University of Pittsburgh School of Medicine. “Regular blood pressure monitoring helps ensure that pregnant women and all pregnant people receive timely, appropriate medical care.”
Hypertensive disorders of pregnancy include gestational hypertension, preeclampsia, eclampsia, and chronic hypertension with or without preeclampsia. Usually characterized by high blood pressure, these conditions can cause stroke, retinal detachment, organ damage, and seizures in the pregnant patient. Fetal complications may include fetal growth restriction, low birth weight, preterm birth, and stillbirth.
Rates of hypertensive disorders of pregnancy in the United States have risen over recent decades, from about 500 cases per 10,000 deliveries in the early 1990s to more than 1,000 per 10,000 in the mid-2010s.
In this update, the USPSTF issued a Grade B recommendation, meaning that blood pressure monitoring in pregnancy has a “substantial net benefit” for screening for hypertensive disorders and clinicians should offer or provide it. The organization emphasized that monitoring is “critically important” for all pregnant women and pregnant people of other gender identities. Abnormal screening results should prompt immediate evidence-based intervention and management.
Dr. Davis identified the following high-risk groups requiring particular attention:
People with a history of eclampsia or preeclampsia
People with a family history of eclampsia
People with a previous adverse pregnancy outcome
People with gestational diabetes or chronic hypertension
People with a multiple pregnancy
People in their first pregnancy
People with a high pre-pregnancy body mass index (BMI)
People over age 35
Research also shows that Black, American Indian, and Alaska Native populations have significantly higher incidence and mortality rates from hypertensive disorders of pregnancy than other groups, as well as higher rates of maternal and infant complications and perinatal death.
“We clearly know that screening alone is not enough to address the health disparities these groups face,” Dr. Davis emphasized. “Healthcare professionals should use more inclusive intervention strategies.”
She recommended stronger postpartum follow-up and coordinated ongoing management involving nurses, midwives, pediatricians, lactation consultants, and others. Telehealth, stronger links with community resources, and multilevel interventions within the “medical home” are also important ways to reduce pregnancy-related health inequities and risks.
Although preeclampsia currently has no cure and delivery remains the only definitive treatment, management options include close maternal and fetal monitoring, antihypertensive medication, magnesium sulfate to prevent seizures, and low-dose aspirin for some high-risk patients.
The USPSTF also called for further research into optimal blood pressure monitoring during and after pregnancy, multilevel approaches to health inequity, expanding access through telehealth, and reducing later cardiovascular complications among patients with hypertensive disorders of pregnancy.
“Continued research in these areas is essential,” Dr. Davis said. “We hope all clinicians will work with us to ensure that every growing family receives the care it needs for the healthiest possible start.”
Knowledge | U.S. Experts Recommend Blood Pressure Checks at Every Prenatal Visit to Prevent Hypertensive Complications
Knowledge | U.S. Experts Recommend Blood Pressure Checks at Every Prenatal Visit to Prevent Hypertensive Complications
The U.S. Preventive Services Task Force (USPSTF) has recommended blood pressure monitoring at every prenatal visit for all pregnant patients to screen for hypertensive disorders of pregnancy. This update expands its 2017 preeclampsia screening recommendation to cover all pregnancy-related hypertensive disorders.
“Hypertensive disorders of pregnancy are among the leading causes of severe maternal complications and death,” said task force member Dr. Esa Davis, associate professor of medicine and clinical and translational science at the University of Pittsburgh School of Medicine. “Regular blood pressure monitoring helps ensure that pregnant women and all pregnant people receive timely, appropriate medical care.”
Hypertensive disorders of pregnancy include gestational hypertension, preeclampsia, eclampsia, and chronic hypertension with or without preeclampsia. Usually characterized by high blood pressure, these conditions can cause stroke, retinal detachment, organ damage, and seizures in the pregnant patient. Fetal complications may include fetal growth restriction, low birth weight, preterm birth, and stillbirth.
Rates of hypertensive disorders of pregnancy in the United States have risen over recent decades, from about 500 cases per 10,000 deliveries in the early 1990s to more than 1,000 per 10,000 in the mid-2010s.
In this update, the USPSTF issued a Grade B recommendation, meaning that blood pressure monitoring in pregnancy has a “substantial net benefit” for screening for hypertensive disorders and clinicians should offer or provide it. The organization emphasized that monitoring is “critically important” for all pregnant women and pregnant people of other gender identities. Abnormal screening results should prompt immediate evidence-based intervention and management.
Dr. Davis identified the following high-risk groups requiring particular attention:
People with a history of eclampsia or preeclampsia
People with a family history of eclampsia
People with a previous adverse pregnancy outcome
People with gestational diabetes or chronic hypertension
People with a multiple pregnancy
People in their first pregnancy
People with a high pre-pregnancy body mass index (BMI)
People over age 35
Research also shows that Black, American Indian, and Alaska Native populations have significantly higher incidence and mortality rates from hypertensive disorders of pregnancy than other groups, as well as higher rates of maternal and infant complications and perinatal death.
“We clearly know that screening alone is not enough to address the health disparities these groups face,” Dr. Davis emphasized. “Healthcare professionals should use more inclusive intervention strategies.”
She recommended stronger postpartum follow-up and coordinated ongoing management involving nurses, midwives, pediatricians, lactation consultants, and others. Telehealth, stronger links with community resources, and multilevel interventions within the “medical home” are also important ways to reduce pregnancy-related health inequities and risks.
Although preeclampsia currently has no cure and delivery remains the only definitive treatment, management options include close maternal and fetal monitoring, antihypertensive medication, magnesium sulfate to prevent seizures, and low-dose aspirin for some high-risk patients.
The USPSTF also called for further research into optimal blood pressure monitoring during and after pregnancy, multilevel approaches to health inequity, expanding access through telehealth, and reducing later cardiovascular complications among patients with hypertensive disorders of pregnancy.
“Continued research in these areas is essential,” Dr. Davis said. “We hope all clinicians will work with us to ensure that every growing family receives the care it needs for the healthiest possible start.”
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