“We sometimes try to normalize it — they look healthy, and seem to be doing great. But it might be an important signal,” Dr. Pettker said, adding that the medical community had “a lot of work to do to make sure that we take even mild blood pressure as a signal to pay attention to, and to pay attention in the same way for all the different people who present to us for prenatal care.”
Blood pressure disorders have potentially serious long-term repercussions for the mother and the baby, and they are linked to preterm births and stillbirths, as well as to a long-term risk of heart disease in the mother.
Hypertension can restrict fetal growth because it impedes blood flow, and can result in a medically induced preterm birth, because delivery of the baby resolves the disease and may be necessary to save the mother’s life and health.
Women who had pre-eclampsia when they delivered are also at high risk of developing heart failure after childbirth, and Black women are at double the risk of white women, according to new findings by Truveta Research, the research arm of Truveta, a for-profit collective of health systems that uses de-identified patient data for research.
Though the reasons for the disparity are not known, some may be caused by unequal access to care and by the failure of care givers to listen when women report unusual symptoms, Dr. Charlotte Baker, Truveta’s director of epidemiology, said. Dr. Baker lost a friend to the condition just months after the friend gave birth.
“My friend had complained multiple times to her physicians, but they brushed her off,” she said.
No one knows exactly why hypertensive disorders have doubled in prevalence in the past three decades, but women are having children at older ages than in the past. They are heavier than they used to be, as are all Americans, and a greater number have high blood pressure even before they become pregnant.
Living conditions, known as social determinants of health, also play a role in maternal health, and recent studies have implicated housing instability and food insecurity in blood pressure disorders and other pregnancy complications. Disparities in access to health care services may also play a role.
Maternal mortality rates in the United States have been rising in recent decades, and rose in 2021 to 1,178 deaths, up from 861 deaths in 2020, according to provisional figures in a recent Government Accountability Office report.