Health researchers are noticing a growing problem in American pregnancies: more cases of blood pressure so high it can be deadly for the parent and baby.
U.S. rates of newly developed and chronic maternal high blood pressure skyrocketed from 2007 through 2019, and researchers say they haven’t slowed down. Hospitals are working to adjust their standards of care to match best practices.
Sara McGinnis died as a result of her pregnancy in 2018. Her Kalispell, Montana, medical team didn’t recognize her symptoms of rising high blood pressure: a severe headache, swollen body and fatigue beyond anything she’d experienced in her first pregnancy. She suffered a massive stroke and seizure late in pregnancy and never got to meet her son, who survived an emergency delivery.
McGinnis had eclampsia, a condition typically characterized by seizures late in pregnancy. The severe and sometimes deadly pregnancy complication generally develops from persistent high blood pressure. Rising blood pressure makes the heart work in overdrive, which damages organs along the way.
One reason for the big increase in cases is that more doctors are looking out for the condition. But that’s not enough to explain the increase in the nation’s overall maternal death rate.
Lifestyle and genetic factors play a role, but physician and health researcher Natalie Cameron, with Northwestern University’s Feinberg School of Medicine, said people who don’t have risk factors going into pregnancy are also getting sick more often. More research is needed to understand why.
“Pregnancy is a natural stress test. It’s unmasking this risk that was there all the time,” Cameron said. “And there’s a lot we don’t know.”
The federal government has worked for years to expand training in screening and treatment for severe high blood pressure in pregnancy. The nation’s best-practice guidelines go back to 2015.
Last year, the federal government boosted funding for training to expand implementation of best practices.
“So much of the disparity in this space is about women’s voices not being heard,” said Carole Johnson, head of the federal agency charged with improving access to health care.
But it takes time for hospitals to incorporate those kinds of changes, researchers said.
Take Montana, for example, which last year became one of 35 states to implement the federal patient safety guidelines. That year, more than two-thirds of hospitals in the state provided patients with timely care. Just over half of hospitals did so before the training.
Some hospitals had treatment plans for high blood pressure in pregnancy but found their doctors’ use was “hit or miss.” One health system found that even the way nurses checked pregnant patients’ blood pressure varied.
Wanda Nicholson, who chairs the independent U.S. Preventive Services Task Force, said blood pressure in pregnancy “can change in a matter of days, or in a 24-hour period.”
That’s why, she said, consistent monitoring for high blood pressure is key to keeping people safe.
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Katheryn Houghton
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