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February 08, 2023

Pregnant women should be screened for all hypertensive disorders, U.S. task force recommends

Hypertension and other high blood pressure conditions in pregnancy are on the rise

Women's Health Pregnancy
Hypertensive Disorders in Pregnancy Philip Walker/Pixabay

Studies show that despite blood pressure monitoring, some hypertensive disorders among pregnant women go undiagnosed or untreated.

The U.S. Preventive Services Task Force already recommends screening for preeclampsia during pregnancy, but now the panel of medical experts is proposing to expand the guidelines. Under the new recommendation, doctors would screen for all hypertensive disorders by monitoring a woman's blood pressure throughout pregnancy.

The new guidelines are based on a review of studies published between January 2014 and January 2022 and older data cited in former recommendations. Studies show that despite blood pressure monitoring, some hypertensive disorders among pregnant women go undiagnosed or untreated.

High blood pressure disorders during pregnancy have been on the rise in the United States, according to the Centers for Disease Control and Prevention. A 2022 CDC report found that their prevalence in pregnancy among delivery hospitalizations increased from about 13% in 2017 to 16% in 2019.

The federal agency said these disorders affected at least 1 in 7 delivery hospitalizations during this three-year time period. About one-third of those who died during hospital delivery had a documented hypertensive disorder of pregnancy.

“Most pregnant people have their blood pressure taken at some point during pregnancy, and for many, a hypertensive disorder of pregnancy is first diagnosed at the time of delivery,” the task force wrote. “Diagnoses made late offer less time for evaluation and stabilization and may limit intervention options. Future implementation research is needed to improve access to regular blood pressure measurement earlier in pregnancy and possibly continuing in the weeks following delivery.”

Hypertensive disorders include gestational hypertension, preeclampsia/eclampsia and chronic hypertension with and without superimposed preeclampsia.

Gestational hypertension is defined as new-onset hypertension after the 20th week of gestation in a person with previously normal blood pressure, while chronic hypertension is defined as hypertension present prior to pregnancy. It is typically diagnosed before pregnancy or within the first 20 weeks of gestation. Preeclampsia is new-onset hypertension that most often occurs after the 20th week of gestation. It is usually accompanied by either by high levels of protein in urine or any of the following signs or symptoms: low blood platelet count, impaired liver or kidney function, renal insufficiency, fluid on the lungs, headache or vision problems.

Eclampsia, meanwhile, is the new onset of seizures without any other potential cause like epilepsy. Superimposed preeclampsia is preeclampsia that complicates chronic hypertension from another cause. 

Complications from hypertensive disorders of pregnancy, in particular preeclampsia, include stroke, retinal detachment, organ damage or failure, and eclamptic seizures.

New-onset hypertension is diagnosed when a pregnant women has an elevated blood pressure reading – meaning a systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg in the absence of chronic hypertension. If the patient has multiple high readings at least 4 hours a part, they should have undergo evaluation and monitoring, the task force says.

The task force also called attention to persisting disparities among different racial and ethnic groups. Their data shows that older women, Black women and American Indian and Alaska Native women are at higher risk of hypertensive disorders. The prevalence was 20.9% among Black women, 16.4% among American Indian and Alaska Native women, 14.7% among white women, 12.5% among Hispanic women and 9.3% among Asian or Pacific Islander women.

The draft recommendation statement was posted online Tuesday for public comment until March 6, 2023. In the task force's 2017 statement, it already recommended screening blood pressure throughout pregnancy, but the focus was on preventing preeclampsia.

Dr. Esa Davis, a member of the task force and associate professor of medicine at the University of Pittsburgh, told CNN, “If this helps to increase awareness to make sure these high-risk groups are screened, that is something that is very, very important about this new recommendation."

“It helps to get more women screened. It puts it more on the radar that they will then not just be screened but have the surveillance and the treatment that is offered based off of that screening.”

Healthy eating, exercise and certain antihypertensive medication deemed safe during pregnancy are used to manage high blood pressure.

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