名媛直播

Pregnant women should undergo frequent blood pressure checks to identify not just one but all hypertensive disorders of pregnancy, the U.S. Preventive Services Task Force (USPSTF) proposed.

In a , the USPSTF said that all pregnant people should have their blood pressure measured at each prenatal visit to help identify and prevent serious health issues related to hypertensive disorders of pregnancy (B grade recommendation). The group "concludes with moderate certainty that screening for hypertensive disorders in pregnancy with blood pressure measurements has substantial net benefit."

This would extend the Task Force's 2017 final recommendation on to include all hypertensive disorders of pregnancy, which cover gestational hypertension, preeclampsia or eclampsia, and chronic hypertension with and without superimposed preeclampsia.

"Hypertensive disorders of pregnancy are among the leading causes of serious complications and death for pregnant people in the United States," said Task Force member Esa Davis, MD, MPH, of the University of Pittsburgh, in a press release. "Fortunately, measuring blood pressure at each prenatal visit is an effective way to screen for these conditions so pregnant people can receive the care they need."

Management of hypertensive disorders of pregnancy include close fetal and maternal monitoring, antihypertension medications, and magnesium sulfate for seizure prophylaxis when indicated. A finding of preeclampsia can only be treated by delivery, timed according to gestational age and whether severe features of preeclampsia are present.

The USPSTF highlighted the increased risk of maternal chronic hypertension and cardiovascular disease later in life for those with a history of any hypertensive disorder of pregnancy. Even early-stage subclinical coronary artery disease (CAD) is linked back to these conditions.

A found a significant association between history of adverse pregnancy outcomes and imaging-identified CAD in middle age in a cohort of more than 10,000 Swedish women undergoing coronary CT angiography screening. Hypertensive disorders of pregnancy in particular were linked to all five indices of CAD: coronary atherosclerosis, significant stenosis, noncalcified plaque, high segment involvement scores, and coronary artery calcium scores greater than 100.

"Taking a pregnancy history when assessing cardiovascular risk and incorporating adverse pregnancy outcomes, particularly preeclampsia and gestational hypertension, into the risk/benefit discussion around primary preventive strategies and risk factor targets is imperative," wrote Natalie Bello, MD, MPH, of Cedars-Sinai Medical Center in Los Angeles, in an .

"Clinicians must also educate birthing people at the time of their pregnancy to understand the impact of an adverse pregnancy outcome on their risk of future heart disease, encourage them to receive timely preventive care focused on risk factor modification, and empower them to share this important medical history with future clinicians if they are not asked about it. There is no time like the present to redouble the efforts to reduce cardiovascular disease in women," she emphasized.

In particular, USPSTF members highlighted the disproportionately higher rates of maternal and infant morbidity and greater risk for developing hypertensive disorders of pregnancy in Black and American Indian/Alaska Native women. Clinicians are advised to be on alert for the greater risk in these populations in order to "help improve equitable dissemination of preventive measures," such as low-dose aspirin to prevent preeclampsia.

"Importantly, we are using this draft recommendation statement to call attention to the inequities related to hypertensive disorders of pregnancy," said Task Force vice chair Wanda Nicholson, MD, MPH, MBA, of George Washington University in Washington, D.C.

"While taking blood pressure throughout pregnancy is an important first step, screening alone cannot fully address these inequities. We have highlighted additional promising ways to improve health outcomes for those at increased risk and are calling for more research to address this important issue," she continued.

Public comments on the USPSTF's proposed screening are being accepted until March 6.

Comment