Maternal deaths caused by chronic hypertension continue to rise

New research from Rutgers Robert Wood Johnson Medical School’s Department of Obstetrics, Gynecology and Reproductive Sciences found that chronic hypertension is contributing substantially to maternal deaths in the United States, with a particular risk among Black women.

The study analyzed data from more than 155 million births and 3287 hypertension-related maternal deaths among women between 15 and 49 years of age from 1978 to 2018 in the United States. Additionally, the study showed a 15-fold increase in maternal mortality rates associated with chronic hypertension over the 40-year study period.

The incidence of hypertension-related maternal deaths increased with age, with the highest being among women between 45 and 49 years of age. The research team also found 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 study author Cande V. Ananth in a press release. She further noted that problems with access to care and many risk factors for hypertensive complications are higher among Black women than white women.

New strategies are needed to reduce hypertension-related maternal deaths by focusing on improvements in areas such as advanced maternal age, obesity, and racial inequities in care. The research team also mentioned that the findings underscore the need to better identify and treat women with chronic hypertension and develop targeted prenatal interventions, such as tight blood pressure control and efforts to reduce body mass index, according to the press release.

“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 in the press release. “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.”

The findings also have implications for clinical providers, with Ananth noting that the burden of maternal death occurs within the first 6 weeks after pregnancy.

“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,” Ananth said in the press release. “In general, approximately 80%-85% 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 added that the implementation of “obstetrics bundles” for high-risk conditions should be more widespread, implemented in all US hospitals.

“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 the press release.

REFERENCE

1. Maternal deaths caused by chronic hypertension continue to rise. EurekAlert! January 3, 2022. Accessed January 4, 2022. https://www.eurekalert.org/news-releases/939127

This article was originally published in Pharmacy Times®.