When it comes to maternal care and mortality rates (aka, the rate at which pregnant and postpartum people die), the United States isn’t winning any awards. The country continues to rank last for maternal care and mortality among countries with developed health-care systems—Black women are three times more likely to die from pregnancy-related complications than white women—and outcomes for pregnant people aren’t improving. The fact is, four in five of these deaths are preventable, according to the Centers for Disease Control and Prevention (CDC), and 50 percent of pregnancy-related deaths happen after a pregnancy ends. That means the postpartum period is a critical time for providers to pay attention to symptoms that could signal a serious health issue, including postpartum hypertension.
For most people, though, postpartum care amounts to a photocopied stack of papers given at hospital discharge and a single follow-up appointment between six and eight weeks after delivery. A recent study suggests that this system isn’t enough to keep postpartum people safe.
Dangerous cardiovascular conditions, like postpartum high blood pressure, are relatively common. According to the study, one in ten postpartum people develops high blood pressure within six weeks of giving birth. Often this condition gets missed because patients don’t know what to look out for and providers can’t spot it without an inpatient visit.
We spoke with board-certified OB-GYN Kecia Gaither, MD, who practices at NYC Health and Hospitals in the Bronx, New York, and is an associate professor of clinical obstetrics and gynecology at Weill Cornell Medical College, about why it’s so important to diagnose and treat high blood pressure in the year after giving birth.
What is postpartum hypertension?
When you’re pregnant, the amount of blood volume in your body doubles. This is ultimately a good thing, as it supports your body and the developing fetus. But having so much additional blood in your body puts a lot of extra pressure on your cardiovascular system. “Your heart is pumping extra, and your arteries are under increased strain,” says Dr. Gaither.
For this reason, high blood pressure isn’t uncommon at all during pregnancy. In fact, even a blood pressure reading of 140/90 is considered high, but not severe, during this time. Preeclampsia, postpartum preeclampsia, and gestational hypertension are all serious health issues that can arise. And, while medication, rest, and staying hydrated can help manage high blood pressure during and after pregnancy, your doctor needs to know about it in order to help. Since hypertension often has no symptoms, this can be a problem—when postpartum hypertension goes untreated, it can pose a serious threat to your health, and cause things like damage to your organs, blurred vision, stroke, and seizures.
What does the new research show?
The newest research on postpartum high blood pressure is alarming, and it’s a health issue that seems to be affecting people in marginalized communities at a higher rate. The analysis published in Hypertension looked at 2,400 women who did not have high blood pressure during their pregnancies. The analysis found that about one in ten people developed high blood pressure (defined as 140/90) within a year of giving birth. More than 22 percent of these cases were diagnosed more than six weeks after delivery.
This study was conducted in an urban hospital with the specific aim of estimating how common postpartum hypertension was in a racially diverse population. By looking at a more diverse set of patients, researchers sought to understand more about who is most at risk. Of the study participants, 54 percent of those whose records were analyzed self-identified as Black, while 18 percent self-identified as Latino. With this research, the study authors say they hope to provide more insight into racial disparities in maternal health.
Why does it seem like postpartum hypertension is becoming more common?
There are a few things that could be contributing to a perceived rise in postpartum high blood pressure. First, people are choosing to get pregnant later in life, according to the American College of Obstetricians and Gynecologists (ACOG). Being 35 or older is considered “advanced maternal age” within the obstetrics community—not because you’re older than other people having babies, but because it puts you into a different risk classification. “Advanced maternal age increases your risk for gestational obesity, gestational diabetes, and hypertension during and after pregnancy,” says Dr. Gaither.
The increased use of fertility assistance technologies could also be a potential link, says Dr. Gaither. When you use IVF to get pregnant, you have an increased chance of carrying multiples, which is also a risk factor for high blood pressure, she adds.
Finally, Dr. Gaither says that providers are already increasing their surveillance of how people are doing after giving birth, which is leading to increased detection of postpartum hypertension. But the question remains: Is that enough?
What are providers doing to catch postpartum high blood pressure earlier?
As more research comes out about postpartum hypertension, it’s possible that recommendations for postpartum care will change. A postpartum monitoring period of one-year post-pregnancy might help to ensure high blood pressure is diagnosed and treated, according to the study authors. This type of monitoring could also help with mental health outcomes post-pregnancy. (After all, it’s recommended that newborns see the doctor six times before their first birthday, while moms go only once.)
Until guidelines are updated, it’s important to be aware of postpartum high blood pressure as a possibility. A home blood pressure cuff, while an imperfect instrument, could be good to have on hand at home to do regular blood pressure checks.
“Your provider should be evaluating your vitals, taking a urinalysis, checking any incisions, and talking to you about birth control options at your post-delivery checkup,” Dr. Gaither says. But beyond that, she encourages engaging with your healthcare provider about any concerns you have at all. In other words, while we wait for the U.S. to catch up to other countries’ maternal care systems, you may need to speak up about any heart health worries you have at your next postpartum visit, and maybe even schedule a check-up just because.
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