USPSTF Draft Recommendation Targets Hypertensive Disorders of Pregnancy

The US Preventive Services Task Force this week released a draft recommendation statement that says all pregnant persons should have their blood pressure measured at every prenatal visit to help identify and prevent serious complications related to hypertensive disorders of pregnancy (HDP).

Conditions associated with elevated blood pressure during gestation include gestational hypertension, preeclampsia/eclampsia, and chronic hypertension with and without superimposed preeclampsia. Complications for the infant include substandard growth progress, low birth weight, and stillbirth.

According to the Centers for Disease Control and Prevention, the incidence of HDP has been steadily climbing, increasing from 13% in 2017 to 17% in 2019, affecting at least 1 in 7 delivery hospitalizations during that period.

“Hypertensive disorders of pregnancy are among the leading causes of serious complications and death for pregnant people in the United States,” USPSTF Member Esa Davis, MD, MPH, FAAFP, an associate professor of medicine, clinical and transitional science at the University of Pittsburgh School of Medicine, said in a USPSTF press release. “Fortunately, measuring blood pressure at each prenatal visit is an effective way to screen for these conditions.”

The ”B” grade (Recommended) recommendation, according to the USPSTF statement, would apply to all pregnant persons who do not have a known diagnosis of hypertension and expands on the task force 2017 recommendation statement that recommends BP assessment throughout pregnancy to detect preeclampsia.

In its review of evidence for the expanded recommendation the Task Force assessed comparative effectiveness of 3 different screening approaches that vary by gestational timing, frequency, and modality. Analysis of data on use of home blood pressure measurements to supplement office readings in prenatal care, reduced number of blood pressure measurements for patients at low risk for hypertensive disorders, and indicated vs routine urine screening for proteinuria found the approaches neither reduced nor increased diagnoses of HDP.

The incidence of HDP has been steadily climbing, increasing from 13% in 2017 to 17% in 2019, affecting at least 1 in 7 delivery hospitalizations during that period.

The evidence review also included questions about drivers of disparities in HDP-related health outcomes and potential approaches to address them. The CDC describes racial and ethnic disparities of HDP among hospital deliveries as “stark,” reporting that HDP affects more than 1 in 5 deliveries of Black women and about 1 in 6 deliveries of American Indian and Alaska Native women. Task force members hope the draft statement can help call attention to the widening disparities.

“While taking blood pressure throughout pregnancy is an important first step, screening alone cannot fully address these inequities,” said USPSTF Vice Chair Wanda Nicholson, MD, MPH, MBA, a professor of general obstetrics and gynecology at the University of North Carolina School of Medicine. Nicholson notes that the updated recommendation includes ways to improve these outcomes and the Task Force in its section on research needs and gaps calls for investigations to address health inequities "through the evaluation of multilevel interventions (eg, policies, health systems, and clinical practices) for Black and American Indian/Alaska Native populations burdened by increased morbidity and mortality from hypertensive disorders of pregnancy.”

The risk factors for pregnancy-associated hypertension include a history of eclampsia or preeclampsia, a family history of preeclampsia, a previous adverse pregnancy outcome, having gestational diabetes or chronic hypertension, being pregnant with more than one baby, the pregnancy being the patient’s first, having a high BMI prior to pregnancy and being aged 35 years or older.

The draft recommendation statement and evidence review are posted for public comment on the USPSTF web site.

Comments can be submitted from February 7 to March 6, 2023.