USPSTF: Measure all pregnant persons’ BP at each visit to detect hypertension disorders
The U.S. Preventive Services Task Force has released a draft recommendation stating all pregnant persons should have their BP measured at each prenatal visit to help identify and prevent complications of hypertension disorders.
“Hypertensive disorders of pregnancy are among the leading causes of serious complications and death for pregnant people in the United States,” USPSTF Member Esa Davis, MD, MPH, FAAFP, an associate professor of medicine, clinical and transitional science at the University of Pittsburgh School of Medicine, said in a press release. “Fortunately, measuring blood pressure at each prenatal visit is an effective way to screen for these conditions so pregnant people can receive the care they need.”
The recommendation, a B grade, applies to all pregnant persons without a known diagnosis of hypertension. It expands on the task force’s 2017 recommendation to measure BP throughout pregnancy to detect preeclampsia.
According to data in a 2022 Morbidity and Mortality Weekly Report, the prevalence of pregnancy-associated hypertension rose from 10.8% in 2017 to 13% in 2019, and the prevalence was highest among non-Hispanic Black women and non-Hispanic American Indian and Alaskan Native women. Among maternal deaths during that period, 24.3% had pregnancy-associated hypertension disorders.
The USPSTF had previously established the accuracy of office-based, home-based and ambulatory BP measurements in identifying hypertension in adults. In its updated review, the task force evaluated new evidence on three screening approaches:
- home BP measurements;
- fewer BP measurements for persons at low risk for pregnancy-related hypertension disorders; and
- protein urine screening done only when indicated, rather than at every prenatal visit.
However, the task force said it found “limited evidence on benefits associated with alternative approaches to screening for hypertensive disorders of pregnancy.”
“Research is needed to develop and strengthen clinical screening and management, possibly incorporating telehealth, home-based blood pressure measurement, and postpartum screening,” Jillian T. Henderson, PhD, MPH, an academic researcher at Kaiser Permanente, and colleagues wrote in the draft evidence report.
According to the USPSTF, risk factors for pregnancy-associated hypertension include a history of eclampsia or preeclampsia, a family history of preeclampsia, a previous adverse pregnancy outcome, having gestational diabetes or chronic hypertension, being pregnant with more than one baby, the pregnancy being the patient’s first, having a high BMI prior to pregnancy and being aged 35 years or older.
Task force members said the recommendation is being used to draw awareness to the significant prevalence of pregnancy-associated hypertension disorders in historically underrepresented populations.
“While taking blood pressure throughout pregnancy is an important first step, screening alone cannot fully address these inequities,” USPSTF Vice Chair Wanda Nicholson, MD, MPH, MBA, a professor of general obstetrics and gynecology at the University of North Carolina School of Medicine, said in the release. “We have highlighted additional promising ways to improve health outcomes for those at increased risk and are calling for more research to address this important issue.”
References:
- Ford N, et al. MWWR Morb Mortal Wkly Rep. 2022;doi:10.15585/mmwr.mm7117a1.
- Screening for hypertensive disorders of pregnancy: An evidence update for the U.S. Preventive Services Task Force. https://www.uspreventiveservicestaskforce.org/uspstf/document/draft-evidence-review/hypertensive-disorders-pregnancy-screening. Published Feb. 7, 2023. Accessed Feb. 7, 2023.
- Task Force issues draft recommendation statement on screening for hypertensive disorders of pregnancy. https://www.uspreventiveservicestaskforce.org/uspstf/sites/default/files/file/supporting_documents/hypertensive-disorders-pregnancy-bulletin.pdf. Published Feb. 7, 2023. Accessed Feb. 7, 2023.
Perspective
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It’s positive to see increasing awareness of hypertensive disorders of pregnancy and the need to screen for them, as well as a focus on the disparities in outcomes that we see for Black individuals and American Indian/Alaska Natives. However, it’s important to note that these recommendations will not meaningfully change practice in any way, as clinicians are already screening for high blood pressure in pregnancy and will continue to do so, as we have been doing since the 1930s. Areas where clinicians truly need guidance include the gaps outlined in the report — for example, the optimal incorporation of telehealth and remote patient monitoring and a discussion of how these technologies can impact the known disparities in care and outcomes. Additionally, it is notable that many of the referenced studies within the draft guidance continue to represent data from outside the U.S. and/or a predominantly white study population. We need to ensure that the studies upon which guidelines are based adequately represent the populations at highest risk.
As clinicians, we are also lacking a comprehensive discussion on how we assess risk of hypertensive disorders of pregnancy, a crucial component to reducing adverse outcomes. Guidelines around screening opportunities in early pregnancy can help us optimize care for all patients and accurately identify those at increased risk so that we can personalize their care. In order to achieve meaningful change, we need a paradigm shift in how we assess risk and personalize care in pregnancy.
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Task Force issues draft recommendation statement on screening for hypertensive disorders of pregnancy. https://www.uspreventiveservicestaskforce.org/uspstf/sites/default/files/file/supporting_documents/hypertensive-disorders-pregnancy-bulletin.pdf. Published Feb. 7, 2023. Accessed Feb. 7, 2023.