The prevalence of hypertensive disorders in pregnancy (HDP) among delivery hospitalizations increased from about 13% in 2017 to 16% in 2019, affecting at least 1 in 7 delivery hospitalizations during this period, according to a CDC report. About a third of those who died during hospital delivery had a hypertensive disorder of pregnancy documented.
HDP are common and can cause severe complications for pregnant people, such as heart attacks and strokes, and are a leading cause of pregnancy-related death in the United States. It includes both pregnancy-associated hypertension that begins during or after pregnancy, and chronic hypertension that begins before pregnancy and continues during pregnancy.
“There are many strategies that clinicians can use to identify, monitor, and manage people with hypertensive disorders in pregnancy to prevent severe complications and deaths. A great example is home-monitoring of blood pressure during and following pregnancy,” said Janet Wright, M.D., F.A.C.C., director of CDC’s Division of Heart Disease and Stroke Prevention at the National Center for Chronic Disease Prevention and Health Promotion. “At a systems level, intentional programming like Perinatal Quality Collaboratives can improve the quality of care and health outcomes and translate findings into interventions.”
Characteristics associated with increased risk for HDP, such as advanced maternal age, obesity, and diabetes have increased in the U.S. and may explain the increase in HDP prevalence.
Racial and ethnic disparities of HDP among hospital deliveries are stark, with HDP affecting more than 1 in 5 delivery hospitalizations of Black women and about 1 in 6 delivery hospitalizations of American Indian and Alaska Native women. Factors contributing to racial and ethnic inequities in HDP include differences in access to and quality of health care, and higher prevalence of characteristics associated with increased risk like obesity. Racial bias in the U.S. healthcare system can affect HDP care from screening and diagnosis to treatment. Psychosocial stress from experiencing racism has also been found to be associated with chronic hypertension.
“As healthcare professionals, we must recognize the factors that contribute to racial inequities and work individually and collectively to reduce these rates.” said Wanda Barfield, M.D., M.P.H., director of CDC’s Division of Reproductive Health at the National Center for Chronic Disease Prevention and Health Promotion. “Addressing hypertensive disorders in pregnancy is a key strategy in reducing inequities in pregnancy-related mortality.”
The highest prevalence of HDP was among delivery hospitalizations of women over the age of 45 (31%). HDP was also high among people who reside in rural counties (16%), reside in lower income ZIP codes (16%), and delivered in hospitals in the South (16%) or Midwest (15%).
Disparities based on location might be due to differences in the prevalence of characteristics associated with increased risk of HDP, including diet, tobacco use, physical activity patterns, experiencing poverty, or access to care. Strengthening regional networks of health care facilities providing risk-appropriate maternal care through telemedicine and transferring people with high-risk conditions to facilities that can provide specialty services are strategies to reduce these disparities.
Severe complications and deaths from HDP are preventable with equitable implementation of public health and clinical strategies. These include efforts across the life course for preventing HDP; identifying, monitoring, and appropriately treating those with HDP with continuous and coordinated care; increasing awareness of urgent maternal warning signs; and implementing quality improvement initiatives to address severe hypertension.