Pregnancy is one of life’s most treasured experiences for many women, bringing the welcome gift of a new life. While most pregnancies in the United States occur without difficulties, for 10-20 percent of women, pregnancy brings hypertension—a very unwelcome complication.
New research from scientists at the University of Pittsburgh School of Medicine and UPMC Magee-Womens Hospital has shown that this complication disproportionately affects African American women.
What is Hypertensive Disorder?
“Hypertensive disorders in pregnancy, like preeclampsia and gestational hypertension, is a broad term for high blood pressure in pregnancy,” explained Alisse Hauspurg, MD, assistant professor at the University of Pittsburgh School of Medicine and a maternal-fetal medicine specialist at UMPC Magee. “Typically, we’ve thought about delivery as a kind of treatment for these complications, but what we now know is that women who have these issues during pregnancy don’t necessarily return to normal after the baby is born.”
Research revealed that Black women have a less rapid decline in blood pressure postpartum resulting in higher blood pressure by the end of the six-week program. At that point, 68 percent of Black women met criteria for stage 1 or stage 2 hypertension compared with 51 percent of white women.
“We know Black women are at increased risk of hypertensive disorders of pregnancy, and we know this contributes to higher morbidity and mortality rates as compared to white women,” said Hauspurg. “Understanding the trajectory of blood pressure decline after a hypertensive disorder of pregnancy might be important to preventing these complications.”
Traditionally, women who suffered hypertensive disorders during pregnancy were instructed to return to their doctor’s office for a blood pressure check about a week after being discharged from the hospital. “We were finding it was challenging for women to get back to the clinic to have their blood pressure monitored with a new baby at home,” said Hauspurg.
As a result, a lot of high blood pressure incidences were not being managed, and the women would only come in for more serious complications which included strokes, seizures and heart failure. Knowing that monitoring high blood pressure in the first several weeks remains critical to preventing complications, UPMC designed an innovative program at the beginning of 2018.
“Every woman that has elevated blood pressure levels during pregnancy is discharged with a blood pressure cup,” said Hauspurg. “The women are instructed on how to check their blood pressure and prompted to text their blood pressure readings to a medical team of nurses and physicians. If necessary, we can start medication through the program without requiring an office visit.
“Obviously, if they develop extremely high blood pressure or concerning symptoms, we will tell them to come in, but the goal is to treat women where they are,” she added.
Through the program, UPMC has collected a lot of information about what happens during the first six-weeks post-delivery. “Black women—at least in our region—seem to have slower return-to-normal blood pressure levels,” said Hauspurg.
Addressing Racial Disparities
Ongoing studies by UPMC are underway to address the racial disparities of high blood pressure. “Through our clinic, we’ve extended the monitoring program through the first-year post-partum to address outstanding issues,” said Hauspurg.
Incidences of high blood pressure are increasing for women both in pregnancy and outside of pregnancy, which may be related to obesity and also increased risks for women getting pregnant later in life.
As for African American women, UPMC has launched a follow-up study to seek more answers. “We’re looking at socio-economic differences right now,” said Hauspurg. “By identifying higher-risk neighborhoods or areas, we can modify and improve the care that we deliver to these communities.”
By collecting large amounts of data over the life course, UPMC hopes to change the direction of this critical issue in the future for all expectant mothers.