USPSTF Issues Recommendation for Hypertensive Disorders in Pregnancy

The United States Preventative Services Task Force (USPSTF) recently issued a draft recommendation —open for public commentary until March 6, 2023 — for hypertensive disorders during pregnancy. Hypertensive disorders during pregnancy refer to gestational hypertension, preeclampsia, eclampsia, and chronic hypertension.

This recommendation is intended for all pregnant individuals, advising blood pressure measurements during every prenatal visit, regardless of existing conditions. The organization notes that hypertensive disorders rapidly evolve and can quickly become serious or fatal, meaning that close, regular monitoring is necessary.

Additional recommendations advise providers to screen for preeclampsia with proteinuria tests. However, the USPSTF does note, “Evidence does not support routine point-of-care urine tests to screen for preeclampsia, as studies suggest that proteinuria alone may not be a good predictor of preeclampsia health outcomes. Proteinuria measurement is used in the diagnostic criteria for preeclampsia.”

The recommendation acknowledges that many of these conditions do not have an “ideal” treatment. The organization heavily urges support for populations more commonly impacted by hypertensive disorders, such as Black and American Indian/Alaska Native populations. 

Additional advice by the USPSTF is to utilize telehealth and remote monitoring, connect patients with community resources during pregnancy, provide collaborative care, and implement multilevel interventions.

These suggestions, and the initiative as a whole, attempt to address the ever-prevalent maternal mortality and morbidity crisis in the US. Disproportionately affecting minority populations and marginalized communities, maternal morbidity and mortality are higher in the US than in any other developed nation.

The Kaiser Family Foundation estimates that each year there are 700 maternal deaths in the US, amounting to approximately 23.8 deaths per 100,000 live births. For Black patients, maternal mortality rates are double the national average at 55.3 deaths per 100,000 live births. New Zealand — the next highest maternal mortality rate among developed nations — has a significantly lower mortality rate than the US at 13.6 deaths per 100,000 live births.

This data suggests maternal morbidity and mortality rates are not a byproduct or limited scientific advancement. Instead, many sources and professionals classify most of these deaths as preventable, noting that most of these deaths can be eliminated with the proper monitoring and access to resources. If implemented as standard practice, these screening protocols can work to minimize preventable deaths.