Screening pregnant people for hypertensive issues throughout the pregnancy and postpartum phases can be lifesaving. These issues are incredibly common, occurring in one in seven pregnant people who give birth in hospitals—but when they’re not caught, the consequences can be fatal. Hypertensive disorders are a leading cause of maternal mortality in the US. From 2012 to 2018, these issues caused nearly 7% of pregnancy-related deaths, per the Centers for Disease Control and Prevention (CDC).
For this reason, among others, the US Preventive Services Task Force (USPSTF) released new guidance this week that emphasizes the importance of regular blood pressure screenings for pregnant people. The Task Force, an independent panel of national experts who do thorough reviews of scientific evidence to make public health recommendations, made similar recommendations in 2017 to help doctors catch complications that can be life-threatening for both pregnant people and their babies, such as preeclampsia and gestational hypertension. The new recommendations reinforce the older guidance and take it further, experts say.
“The USPSTF released this statement in response to rising rates of high blood pressure disorders in pregnancy in the US [that] can lead to serious health complications,” Christina A Penfield, MD, MPH, a maternal-fetal medicine physician at NYU Langone, tells SELF. “The Task Force also identified a need for more studies evaluating…newer prenatal care models that incorporate telehealth and home blood pressure monitoring.”
The recommendations come as the maternal mortality crisis in the US worsens: The number of pregnancy-related deaths in the US has been steadily climbing since the mid-1980s. Maternal mortality also disproportionately affects Black people, who are three times as likely to die from pregnancy-related complications in the US than white women, per the CDC. According to a 2022 report from the US Government Accountability Office, the maternal mortality rate for Black people was 44 of 100,000 live births in 2019; 55.3 in 2020; and 68.9 in 2021. By contrast, the same stats for white women were 17.9 in 2019; 19.1 in 2020; and 26.1 in 2021.
Though the new recommendations from the USPSTF won’t fix the problem—or address these racial inequities—overnight, they’re a step in the right direction, Oluwatosin Goje, MD, an obstetrician-gynecologist at the Cleveland Clinic, tells SELF. “This is more of a reaffirmation of their 2017 [guidance], but it is good that this has been brought back to the fore,” given that the crisis has continually worsened in recent years, Dr. Goje says. Though the recommendations are open for public comment for the next four weeks, she adds that providers should start putting them into practice now. Below, experts explain how the new recommendations may save lives—and what else can be done to address maternal mortality in the US.
What would the new screenings for hypertensive issues look like?
The new screening would ensure consistent blood pressure checks throughout pregnancy and after childbirth, Dr. Goje says. She explains that all pregnant people’s blood pressure should be thoroughly monitored—regardless of whether their blood pressure is usually high. “From the first [ob-gyn] visit, you should be measuring blood pressure,” Dr. Goje says. Doctors should also be reiterating the warning signs of hypertensive issues during pregnancy, so pregnant people—and their partners—can be on the lookout for them.
Red flags pregnant people should watch out for include vision changes, upper abdominal pain, and persistent or unusual headache, Dr. Penfield says. The CDC also notes that swelling of the hands or face, trouble breathing, heavy vaginal bleeding or discharge, and overwhelming tiredness are signs that you should see your doctor ASAP.
A number of health conditions can be caught and addressed through blood pressure screenings throughout the pregnancy and postpartum periods, Dr. Goje says, explaining that monitoring blood pressure can alert doctors to gestational hypertension, which occurs when you only have high blood pressure during pregnancy; preeclampsia, which occurs when a pregnant person’s blood pressure suddenly spikes; and eclampsia, which is a potential consequence of preeclampsia and can cause seizures.
Making regular blood pressure screenings the standard of care may help reduce the disparity between Black and white maternal deaths, Dr. Goje says. This is because routine blood pressure measurements wouldn’t be dismissed by doctors, whereas health complaints from Black pregnant people are sometimes ignored due to their doctors’ racist biases. “Depending on the setting, some patients feel unheard, but when you have your blood pressure measured, this is an objective measurement” of one aspect of your health, she explains. “A provider should see the measurements and act on [them].”
The new recommendations also draw attention to the prevalence of telehealth appointments, which, Dr. Goje explains, is an important topic, given how popular virtual visits became during the pandemic. Some people at major hospitals may be able to take blood pressure cuffs home with them to use throughout their pregnancies and after giving birth, including during telehealth appointments, she says. In these cases, telehealth visits may work, since the provider can watch their patient take their blood pressure and assess whether it’s getting higher. But if a person doesn’t have access to a blood pressure cuff they can use at home, telehealth visits may not cut it, Dr. Goje says. The new recommendations say more research needs to be done to determine how pregnant people and their doctors can utilize telehealth technology without skipping over vital screenings, like blood pressure checks.
What else needs to be done to address the maternal mortality crisis?
Regular blood pressure checks aren’t the only interventions that need to be instituted to keep pregnant people safe. Addressing the maternal mortality crisis—and the fact that it disproportionately affects Black people—would mean making significant changes to our current health care system, Dr. Goje says.
For starters, it would help if all health care personnel who come into contact with pregnant people receive implicit bias training. According to the American Academy of Family Physicians (AAFP), implicit bias is “pervasive” in the health care industry, and it often harms patients.
In addition to training programs that address implicit bias, making sure Black people have access to other community care workers, such as doulas—trained professionals who provide educational, physical, and emotional support and care during pregnancy and childbirth—could also help. That way, if a person feels their voice isn’t heard, their doula (or someone in a similar role) could help them create a birth plan, serve as an advocate, and communicate their concerns to the doctor. “Health care systems are adding more levels of care to our [pregnant] patients [because] evidence supports having a multilevel approach,” Dr. Goje says.
Ultimately, she explains, the new screenings are one step forward within a complex systemic problem that requires our attention: People who work in health care, alongside our lawmakers, need to do much more work to truly reduce Black maternal mortality. This includes collecting more data, providing resources for maternal mental health, and extending Medicaid services to ensure that pregnant people get the support they need during and after childbirth. “There are a lot of racial disparities,” Dr. Goje stresses, “and bringing back [the conversation around] blood pressure in pregnancy is important.”
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