Chronic Hypertension Is A Growing Threat For Pregnant Moms: Study

NEW JERSEY — Chronic hypertension is killing an increasing number of mothers across the United States, according to a study from researchers in New Jersey.

Health experts from Rutgers Robert Wood Johnson Medical School’s Department of Obstetrics, Gynecology and Reproductive Sciences recently published a study that examined data from more than 155 million births and 3,287 hypertension-related maternal deaths among women aged 15 to 49 from 1979 to 2018 in the United States.

Researchers said a troubling statistic emerged: a 15-fold increase over the past 40 years in maternal mortality rates as a result of chronic hypertension, which happens when a pregnant woman has pre-existing hypertension (high blood pressure) or develops it before 20 weeks of pregnancy.

Hypertension-related maternal deaths “sharply increased” with age, being highest among women age 45 to 49. Obesity was also a factor, the study found.

Overall hypertension-associated deaths have declined in the U.S. over the last four decades, according to professor Cande Ananth, who serves as chief of the Division of Epidemiology and Biostatistics.

But the decline is restricted to women who have pre-eclampsia/eclampsia as the cause, Ananth added.

“If you isolate the data on women who have chronic hypertension … as a cause, mortality rates have increased quite substantially – on average, by about 9.2 percent per year over the last 40 years,” Ananth said.

“So it is chronic hypertension that has really driven the maternal mortality trends in the U.S. over the last 40 years,” Ananth added.

Todd Rosen, associate professor and chief of maternal fetal medicine at Rutgers Robert Wood Johnson Medical School, called the results “concerning,” though not necessarily surprising.

“Women are starting their families when they are older and they may be heavier and in a poorer state of health,” Rosen said. “For a portion of the time period studied, the CDC reported that the percentage of first births to women between 30 and 34 rose by 28 percent, and those for women 35 and older rose 23 percent.”

“To help reduce hypertension-related deaths in these groups, we all need to work to ensure women are in optimal health before they start their families,” Rosen continued.

RACIAL DISPARITY

Researchers also said there was a “substantial race disparity” in the trends of maternal mortality rates due to hypertensive conditions.

“Black women were at anywhere from three-to four-fold increased risk of dying from a hypertension-related cause compared to white women in the United States, and this disparity has persisted for the last 40 years,” said professor Cande Ananth, who serves as chief of the Division of Epidemiology and Biostatistics.

Ananth said problems with access to care and many risk factors for hypertensive complications are higher among Black women than white women, which contributes to the disparity.

• Read More: Here's The Plan To Fix New Jersey's 'Racist' Infant Mortality Gap
• Read More: NJ Nurses Will Visit Newborns At Home To Fight Baby Mortality Gap

WHAT CAN BE DONE?

So what can be done about the problem? Here’s what researchers said:

“Strategies are needed to reduce hypertension-related maternal deaths by focusing improvements in such areas as advanced maternal age, obesity and racial inequities in care – issues deserving urgent public health attention. Findings also underscore the need to better identify and treat women with chronic hypertension and develop targeted prenatal interventions, including tight blood pressure control and efforts to reduce body mass index.”

“We have gotten much better at treating women with pre-eclampsia/eclampsia during pregnancy, which has undoubtedly contributed to the decline in maternal death rates, but we haven’t done as good a job in treating women with chronic hypertension,” Ananth said.

“Part of that is because many of these women come in undiagnosed, and it’s often problematic to treat women with drugs to reduce their blood pressure, particularly early in pregnancy, so there’s a conflict of what’s the right approach,” Ananth said.

It’s important to note that hypertensive complications can be reduced by making healthy lifestyle choices – particularly about smoking, alcohol, weight and a balanced diet – before pregnancy and early in pregnancy, Ananth added.

The study findings have implications for clinical providers as well, he said, noting that the burden of maternal deaths occurs within the first 42 days after pregnancy.

According to Ananth:

“Women who have any obstetrical complications, particularly hypertension-related complications, should be monitored very closely during the course of pregnancy and delivery, as well as in the postpartum period. Following these women after pregnancy is crucial. In general, approximately 80-85 percent of women who experienced pre-eclampsia/eclampsia during their pregnancy see those symptoms resolve after the placenta is delivered, but for the remaining one-fifth of women, the hypertension condition persists for the remainder of her life. These women are particularly vulnerable and high risk, and need to be monitored carefully and treated for hypertensive conditions, particularly through medication and changes in lifestyle/behavior.”

Ananth said he also believes the implementation of “obstetrics bundles” for high-risk conditions should be more widespread at hospitals in the United States.

“These bundles set the stage for identification, treatment and prevention of various obstetrical complications, including hypertension, and their effectiveness has been well documented in several studies, including those in New York, as well as in California,” he said.

In addition to Ananth and Hillary Graham from the Division of Epidemiology and Biostatistics, study authors included Justin Brandt, Jennifer Hill, Meike Schuster and Haylea Patrick from the Division of Maternal Fetal Medicine, and Sonal Grover from the Division of General Obstetrics and Gynecology, all in Robert Wood Johnson Medical School’s Department of Obstetrics, Gynecology and Reproductive Sciences, as well as K.S. Joseph from the University of British Columbia, Vancouver, Canada.

Send local news tips and correction requests to eric.kiefer@patch.com

Sign up for Patch email newsletters. Learn more about posting announcements or events to your local Patch site.