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5 Things to Know About Hypertension in Pregnancy

5 Things to Know About Hypertension in Pregnancy

Janet S. Wright, MD, MACC, FPCNA 
Director, Division for Heart Disease and Stroke Prevention 
National Center for Chronic Disease Prevention and Health Promotion 
Centers for Disease Control and Prevention

Janet S. Wright, MD, MACC, FPCNAHypertension, or high blood pressure, is a serious public health issue and a leading cause of death and disability, both globally 1 and in the U.S.2 Nearly 50% of US adults have hypertension, and nearly half are women, including almost 1 in 6 women of reproductive age.3

In recent years, hypertension in pregnancy has increased,4 which increases risk for mother and baby, both immediate and long-term. These risks may be reduced through timely detection and management of hypertension during and following pregnancy.

As we recognize National Women’s Blood Pressure Awareness Week and the importance of blood pressure control across the lifespan, here are five things women and their health care teams need to know about hypertension in pregnancy.

1. Hypertension in pregnancy threatens both mother and baby.

Hypertension can be a chronic condition predating pregnancy or developing during pregnancy. Types of pregnancy-associated hypertension include gestational hypertension, preeclampsia, eclampsia, and chronic hypertension with superimposed preeclampsia or eclampsia. The impact of hypertension in pregnancy does not end when the pregnancy and postpartum periods are over. Pregnant women with hypertension have about twice the risk of subsequent heart disease as pregnant women without hypertension. Children born to women with hypertension have a higher risk for hypertension themselves,5 as well as an increased lifetime risk of dying from cardiovascular disease.6,7

2. Most pregnancy-related deaths stemming from hypertension are preventable.

Unfortunately, hypertension is often undetected or untreated during and following pregnancy. One study suggested that 60% of deaths attributed to preeclampsia/eclampsia had a ”good-to-strong” chance of being prevented.8 To avoid preventable deaths, hypertension in pregnancy must be recognized early and effectively managed.

3. Prompt identification and management of rising blood pressure readings can be lifesaving.

Screening for hypertension during routine visits can be beneficial for all women across the lifespan.9 Home monitoring of blood pressure is the best way for women to know and understand their blood pressure patterns.

Throughout pregnancy, most women see their health care teams regularly, providing opportunities for lifestyle counseling and medications if necessary for hypertension. Postpartum visits provide additional opportunities. By finding and treating individuals with undiagnosed hypertension “hiding in plain sight,”10 health care teams can save lives and prevent life-changing complications for both mother and child.

4. Health care and public health professionals play pivotal roles in equity and safety during pregnancy.

Notable health disparities exist among different racial and ethnic groups. For instance, non-Hispanic Black (20.9%) and American Indian/Alaska Native (16.4%) women have the highest prevalence of hypertension during delivery hospitalization.4 The prevalence of hypertension in pregnancy is also higher for women who are ≥ 35 years of age, live in the South and Midwest, live in rural counties, or live in areas with the lowest median household income. These disparities likely stem from underlying factors, such as health care access and quality; availability of nutritious, affordable food and safe places to be physically active; and structural racism, including systemic racial and gender bias within the health care system.11,12,13,14,15,16,17,18

Stratifying data by race and ethnicity, age, insurance status, preferred language, and other social drivers of health can help identify and address health care gaps in communities. Health care teams can implement policies and processes to train all patient-facing staff in respectful and culturally safe communication, being mindful of communication needs, such as health literacy and language barriers, as well as various family structures and cultural practices.

5. The Million Hearts® Hypertension in Pregnancy Change Package offers valuable resources for clinical teams in outpatient settings.

Developed by and for clinicians, the Hypertension in Pregnancy Change Package is a compilation of ready-to-implement strategies to improve hypertension management and reduce its complications. Strategies include self-measured (home or out-of-office) blood pressure monitoring, aspirin use to prevent preeclampsia, healthy lifestyle recommendations, and anti-hypertensive medications that are safe and effective during pregnancy and lactation. The change package also includes tools for implicit bias training, warning signs and symptoms, and more.

The Hypertension in Pregnancy Change Package was developed by CDC’s Division for Heart Disease and Stroke Prevention, with the Division of Reproductive Health and in partnership with the American Academy of Family Physicians, the American College of Nurse-Midwives, the American College of Obstetricians and Gynecologists, the American College of Osteopathic Obstetricians and Gynecologists, the American Medical Association, the National Association of Nurse Practitioners in Women’s Health, and the Society for Maternal-Fetal Medicine.

Additional Resources:

Follow CDC’s Division for Heart Disease and Stroke Prevention on X.
Follow Million Hearts® on LinkedIn.

References:

  1. Mills, K. T., Stefanescu, A., & He, J. (2020). The global epidemiology of hypertension. Nature reviews. Nephrology, 16(4), 223–237. https://doi.org/10.1038/s41581-019-0244-2.
  2. National Center for Health Statistics. Multiple Cause of Death 2018–2022 on CDC WONDER Database. Accessed May 3, 2024. https://wonder.cdc.gov/mcd.html
  3. Weng X, Woodruff RC, Park S, Thompson-Paul AM, He S, Hayes D, Kuklina EV, Therrien NL, Jackson SL. Hypertension Prevalence and Control Among U.S. Women of Reproductive Age. Am J Prev Med. 2024 Mar;66(3):492-502. doi: 10.1016/j.amepre.2023.10.016. Epub 2023 Oct 24. PMID: 37884175; PMCID: PMC10922595.
  4. Ford ND, Cox S, Ko JY, et al. Hypertensive Disorders in Pregnancy and Mortality at Delivery Hospitalization - United States, 2017-2019. MMWR Morb Mortal Wkly Rep. 2022;71(17):585-591. Published 2022 Apr 29. doi:10.15585/mmwr.mm7117a1
  5. Dines VA, Kattah AG, Weaver AL, et al. Risk of Adult Hypertension in Offspring From Pregnancies Complicated by Hypertension: Population-Based Estimates. Hypertension. 2023;80(9):1940-1948. doi:10.1161/HYPERTENSIONAHA.123.20282
  6. Huang, C., Wei, K., Lee, P. M. Y., Qin, G., Yu, Y., & Li, J. (2022). Maternal hypertensive disorder of pregnancy and mortality in offspring from birth to young adulthood: national population based cohort study. BMJ (Clinical research ed.), 379, e072157. https://doi.org/10.1136/bmj-2022-072157. Corrected in Maternal hypertensive disorder of pregnancy and mortality in offspring from birth to young adulthood: national population based cohort study. (2022). BMJ (Clinical research ed.), 379, o2726. https://doi.org/10.1136/bmj.o2726
  7. Hammad IA, Meeks H, Fraser A, et al. Risks of cause-specific mortality in offspring of pregnancies complicated by hypertensive disease of pregnancy. Am J Obstet Gynecol. 2020;222(1):75.e1-75.e9. doi:10.1016/j.ajog.2019.07.024
  8. Main EK, McCain CL, Morton CH, Holtby S, Lawton ES. Pregnancy-related mortality in California: causes, characteristics, and improvement opportunities. Obstet Gynecol. 2015;125(4):938-947. doi:10.1097/AOG.0000000000000746
  9. ACOG Committee Opinion No. 755: Well-Woman Visit. Obstet Gynecol. 2018;132(4):e181-e186. doi:10.1097/AOG.0000000000002897
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  11. Johnson JD, Louis JM. Does race or ethnicity play a role in the origin, pathophysiology, and outcomes of preeclampsia? An expert review of the literature. Am J Obstet Gynecol. 2022;226(2S):S876–S885.
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  13. Meyerovitz CV, Juraschek SP, Ayturk D, Moore Simas TA, Person SD, Lemon SC, et al. Social determinants, blood pressure control, and racial inequities in childbearing age women with hypertension, 2001 to 2018. J Am Heart Assoc. 2023;12(5):e027169. CHANGE PACKAGE | 51
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  15. Baiden D, Parry M, Nerenberg K, Hillan EM, Dogba MJ. Connecting the dots: structural racism, intersectionality, and cardiovascular health outcomes for African, Caribbean, and Black mothers. Health Equity. 2022;6(1):402–-405.
  16. Howell EA, Brown H, Brumley J, Bryant AS, Caughey AB, Cornell AM, et al. Reduction of peripartum racial and ethnic disparities: a conceptual framework and maternal safety consensus bundle [published correction appears in Obstet Gynecol. 2019 Jun;133(6):1288]. Obstet Gynecol. 2018;131(5):770–782.
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  18. Mohamoud YA, Cassidy E, Fuchs E, Womack LS, Romero L, Kipling L, et al. Vital signs: maternity care experiences—United States, April 2023. MMWR Morb Mortal Wkly Rep. 2023;72(35):961–967
Heart Health, Stroke, and Diabetes
Pregnancy
Healthcare and Women