Frequent monitoring needed during, after pregnancy
Health care providers must check pregnant patients’ blood pressure regularly, starting early in pregnancy and continuing for at least six weeks after childbirth, according to new draft recommendations from the U.S. Preventive Services Task Force.
The task force issued the draft recommendations Tuesday amid growing concern about a rise in maternal mortality. Pregnancy-related deaths in the United States are the highest among industrialized nations, and hypertensive disorders from pregnancy are among the leading causes.
Blood pressure disorders in pregnancy have doubled in prevalence in the past three decades, affecting 1 in 10 pregnancies now, up from 1 in 20 in 1993. They are a leading cause of death during and after pregnancy among Native American women and the leading cause of death among Black women.
The groups face maternal mortality rates that are up to three times as high as those among white women. The disorders pose a high risk of stroke to Black and Hispanic women, the task force noted. Yet women of color were underrepresented in most clinical trials that tested screening regimens for the condition. The task force called on health care providers to offer better support for pregnant women of color, and for physicians to be aware of their increased risks so they can “focus clinical energy and resources to those most likely to suffer morbidity or mortality.”
“Our moms are dying,” said Dr. Wanda Nicholson, vice chair of the task force, adding that the new draft recommendations aimed “to call attention to the racial disparities in maternal deaths and morbidity.”
The recommendations call for more research into the conditions, and they urge doctors and midwives to use standard, evidence-based treatment for all patients.
Not all pregnant women who are affected receive the recommended care for blood pressure disorders, though Black women are more likely to get appropriate care than white women.
The onset of a severe blood pressure condition called preeclampsia/eclampsia often occurs after the first 20 weeks of pregnancy. Low- dose aspirin starting at 12 weeks gestation is recommended for women at heightened risk — a large group that includes patients with preexisting conditions such as diabetes or lupus, those who are 35 and older or younger than 15, patients who have undergone in vitro fertilization, and those pregnant for the first time.
Maternal mortality rates in the United States rose in 2021 to 1,178 deaths, up from 861 deaths in 2020, according to provisional figures in a recent Government Accountability Office report.