Fatal high blood pressure during pregnancy on the rise

More pregnant women are being diagnosed with dangerously high blood pressure today, a finding that could be lifesaving. Recent studies have shown that rates of new-onset and chronic maternal hypertension have nearly doubled since 2007. Researchers say the surge in cases is likely due in part to increased testing to detect these conditions.

But that's not the whole story. Data shows that overall maternal mortality in the U.S. is also rising. High blood pressure One of the main causes.

Medical experts are trying to reverse the trend: In 2022, the American College of Obstetricians and Gynecologists lowered its standards for treating high blood pressure for pregnant and postpartum patients, and federal agencies are providing training on best practices for testing and treatment.

After implementing these guidelines, maternal deaths from high blood pressure fell in Alaska and West Virginia, according to federal data. But implementing these standards into routine care has been slow, and hospitals are still working to implement the treatments that may have saved Sarah's life.

In Montana, which became one of 35 states to implement federal patient safety guidelines last year, more than two-thirds of hospitals provided timely care to patients, said Annie Glover, senior research scientist at the Montana Perinatal Quality Collaborative. As of 2022, just over half of hospitals are meeting the standards.

“It takes some time to implement change in a hospital,” Glover said.

High blood pressure can damage a person's eyes, lungs, kidneys, and heart, with effects long after pregnancy. Preeclampsia (persistent high blood pressure during pregnancy) can also lead to a heart attack. The problem can develop from genetic or lifestyle factors. For example, being overweight makes you more susceptible to high blood pressure. The same is true for the aging population, with more and more people giving birth at an older age.

Black and Indigenous people are much more likely to develop and die from high blood pressure during pregnancy than the general population.

“Pregnancy is nature's stress test,” says Natalie Cameron, a physician and epidemiologist at Northwestern University Feinberg School of Medicine, who has studied the rise in high blood pressure diagnoses. “It exposes risks that have been there all along.”

but Pregnant women People who don't fit the typical risk profile are also getting sick, and more research is needed to understand why, Cameron said.

The typical treatment for preeclampsia is delivery of the baby. If the health of the mother or baby requires early delivery, medications can be used to prevent attacks and speed up the baby's growth, shortening the pregnancy. In rare cases, preeclampsia can develop shortly after birth, a condition that researchers don't yet fully understand.

Wanda Nicholson, chair of the U.S. Preventive Services Task Force, an independent panel of disease prevention experts, said continued monitoring during pregnancy and after birth is necessary to truly protect patients. “Blood pressure can change over a period of days or even 24 hours,” Nicholson said.

And the symptoms aren't always clear.

That's what happened to Emma Trotter: A few days after giving birth to her first child in San Francisco in 2020, she felt her baby's heartbeat slow down. Trotter called a doctor and nurse helpline, both of which encouraged her to go to the hospital. emergency room She seemed concerned but was told there was no need, so she stayed home.

In 2022, four days after giving birth to her second child, her heart rate slowed again, and that's when her care team in Missoula, her new home, checked her vital signs. Her blood pressure was so high that the nurses thought the monitor was broken.

“You could have a stroke at any moment,” Trotter recalled the midwife telling her before being sent to hospital.

Trotter was due to give birth to her third child in September, and doctors planned to hook her and her newborn baby up to a blood pressure monitor before sending them home.

Increased surveillance could help solve a complex maternal health problem, said Stephanie Leonard, an epidemiologist at the Stanford University School of Medicine who studies high blood pressure during pregnancy.

“Blood pressure is one of those things we can really influence,” she says. “It's measurable and it's treatable.”

Increased oversight has been a long-standing goal: In 2015, the federal Health Resources and Services Administration worked with the American College of Obstetricians and Gynecologists to roll out best practices to make childbirth safer, including specific guidelines for testing and treating high blood pressure. Last year, the federal government increased funding for efforts to expand implementation of those guidelines.

“So many of the disparities in this space are because women's voices are not being heard,” said Health Resources and Services Administration Commissioner Carol Johnson.

The Montana Perinatal Quality Collaborative has been providing training on hypertension to hospitals across the state for a year. In the process, Melissa Wolf, director of women's services at Bozeman Health, said the hospital system learned that how doctors were using the hospital's treatment plan for high blood pressure during pregnancy was “hit and miss.” Even the way nurses were taking pregnant patients' blood pressure varied.

“We naively assumed that everyone knew how to take their blood pressure,” Wolf says.

Now, Bozeman Health tracks treatments, with the goal that pregnant women with high blood pressure get the right treatment within an hour. Posters listing warning signs of preeclampsia are posted on the walls of doctor's offices and on bathroom doors at the hospital. Patients leave the hospital with a list of warning signs to look out for.

Katlyn Tonkin is one of the nurses training Montana health care workers on how to make childbirth safer. She knows from experience how important it is: In 2018, at 36 weeks pregnant, Tonkin was diagnosed with severe preeclampsia, a condition that began weeks after she first began to show symptoms. An emergency delivery came too late, and her son, Dawson, died shortly after birth because he wasn't getting enough oxygen.

Tonkin went on to have two more sons, both healthy children, and keeps photographs of Dawson's short life displayed throughout her home.

“I wish I knew then what I know now,” Tonkin said. “We're using evidence-based practices now. We just need to make sure they're being implemented.”

2024 KFF Health News. Distributed by Tribune Content Agency, LLC.