Chronic hypertension has soared among pregnant women. Treatment is not keeping pace

Far more women are experiencing a life-threatening condition during pregnancy but aren't being treated for it, according to a study published this week.

This problem is largely avoidable, and experts have urged providers to take action. One official called it a "missed opportunity" to protect heart health.

The study found the rate of chronic high blood pressure in pregnant women doubled over a 14-year period. At the same time, the use of medications that can treat the condition, also called hypertension, remained flat, even as maternal deaths rose alarmingly in recent years.

“Untreated high blood pressure can have really serious consequences for both someone who’s pregnant and the baby in the short term, as well as over their whole life,” Stephanie Leonard, an assistant professor in maternal-fetal medicine and obstetrics at Stanford School of Medicine and the study’s lead author, told USA TODAY.

As chronic hypertension in pregnant women doubled from 2007 to 2021, only about 3 in 5 received medications to treat it, according to the study in an American Heart Association journal.

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Chronic high blood pressure during pregnancy is when a person's readings are 140/90 millimeters of mercury or higher before pregnancy or within the first 20 weeks of pregnancy, according to the National Institutes of Health, which supported the study with grant funding.

High blood pressure during pregnancy can cause organ damage in mothers and increase the risk of preterm birth or low birth weight babies. Care providers consider hypertension a threat to both mother and baby because preterm delivery poses serious risks for children as they develop. It can also be fatal to mothers who don't get treatment, and it's a problem federal health officials say is largely avoidable. New federal data suggests the number of women who died during childbirth has dropped significantly after alarming increases early in the COVID-19 pandemic.

Women of color, particularly Black and Indigenous people, are at greater risk of dying during or after childbirth. Black women die at nearly three times the rate of white women, according to a recent report from the Centers for Disease Control and Prevention.

“We need to better understand gaps in treatment for chronic hypertension, especially in these high-risk groups,” said Candice A. Price, a program director at NIH’s National Heart, Lung, and Blood Institute, who researches women’s health, in a statement. “If we’re not detecting and treating chronic hypertension early, that’s a missed opportunity for protecting heart health during and after pregnancy.”

The study, published Monday in the journal Hypertension, drew from private insurance claims of 1.9 million pregnant people ages 12 to 55 looking at cases of chronic hypertension, and how frequently medical providers treated it. Cases of hypertension leaped from 1.8% in 2008 to 3.7% in 2021. But the use of medication for pregnant patients to treat hypertension remained relatively unchanged, 57% in 2008 and 60% in 2021.

Researchers accounted for the change in diagnostic criteria for chronic hypertension that changed with lower blood pressure levels set in 2017 by the American College of Cardiology and the American Heart Association's updated guidance.

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Dr. Alan Tita, a professor of obstetrics and gynecology at the University of Alabama at Birmingham Heersink School of Medicine, has led the nationwide Chronic Hypertension and Pregnancy trial to look at medical treatment for the condition. Based on its findings, the American College of Obstetrics and Gynecology recommended medical treatment in 2022 if blood pressure levels surpassed 140/90.

The study this week reflects the increase in chronic hypertension in pregnant patients that Tita and his colleagues have seen in the field, and the need for medications to treat it.

The new study didn’t examine why there has been a rise in chronic high blood pressure among pregnant women. It appeared to show increases in hypertension could be associated with people having babies later in life, as a decades-long 2019 study suggested. Other factors, researchers said, could be increased “vigilance in diagnosis” to detect high blood pressure. Obesity is thought to be a contributing factor, but Leonard, of Stanford, said obesity rates among reproductive women have largely leveled, which makes it an unlikely cause for increases in chronic hypertension rates.

Researchers noted the data, which comes from private insurance claims, does not reflect hypertension among people who use Medicaid or other payment methods. Tita speculated that people on Medicaid or uninsured people may face higher levels of chronic high blood pressure and greater barriers to care.

Leonard plans to research how effective medications are at treating chronic hypertension. Her recent study looked at shifts over time in what medicines are used. She said there isn't clear evidence about which meds work best for patients.

She said there are simple solutions to curb maternal deaths and avoid severe complications. If providers improve diagnosis and offer robust treatment, they can save lives. There are also remedies for people who are pregnant or hoping to become pregnant. She recommended patients keep track of blood pressure and, if concerns arise, discuss options with their doctors.

This article originally appeared on USA TODAY: Hypertension is up among pregnant women. Why is treatment lagging?