March 6, 2023
We are writing to express our views on the USPSTF draft statement recommending screening of asymptomatic women for hypertensive disorders of pregnancy.
The National Center for Health Research (NCHR) is a nonprofit think tank that conducts, analyzes, and scrutinizes research on a range of health issues, with particular focus on which prevention strategies and treatments are most effective for which patients and consumers. We do not accept funding from companies that make products that are the subject of our work, so we have no conflicts of interest.
We strongly support the task forces draft recommendations that all asymptomatic pregnant women be screened with blood pressure measurements throughout pregnancy. While researchers found limited evidence to evaluate specific screening tools, we appreciate the agency highlighting interventions that will help prevent adverse outcomes related to hypertensive disorders of pregnancy.
The maternal mortality rate in the U.S. is much higher than in many other countries and has a disproportionate impact on non-Hispanic Black women. Causes of pregnancy-related death in Black women are most often related to cardiovascular health including conditions such as hypertension. Compared to White women, Black women who were newly diagnosed with hypertension during pregnancy are three times more likely to suffer fatal complications.1 Additionally, for every Black maternal death, there are more than 100 cases of severe morbidity – double the number of cases among White women. These pregnancy-related complications often lead to lifelong health problems. For example, women who had preeclampsia are four times more likely to develop heart failure and twice as likely to experience coronary artery disease, stroke and death due to coronary artery or cardiovascular disease.2
NCHR strongly agrees with the task force’s call for interventions that increase clinician awareness of those groups at highest risk of hypertensive disorders and adverse pregnancy outcomes and encourage clinicians to direct resources to those most likely to experience complications. We also appreciate that the USPSTF recognizes the impact of certain pregnancy complications on long-term cardiovascular health and encourages clinicians to incorporate reproductive health history in decisions about preventive healthcare. In addition, we support the task force’s recommendation that screening, monitoring, and risk assessment continue throughout the postpartum period since 53% of maternal deaths occur between one week and one year after delivery.3 Of these maternal deaths, about 6.5% are caused by hypertensive disorders of pregnancy.
NCHR thanks the USPSTF for focusing on the important issue of maternal mortality and we look forward to seeing future research that will further advance efforts to limit the devastating impact of hypertensive disorders of pregnancy.
National Center for Health Research can be reached at email@example.com or at (202) 223-4000.
- Crandall K. Pregnancy-related death disparities in non-Hispanic Black women. Womens Health (Lond Engl). 2021;17:174550652110198. doi:10.1177/17455065211019888
- Wu P, Haththotuwa R, Kwok CS, et al. Preeclampsia and Future Cardiovascular Health: A Systematic Review and Meta-Analysis. Circ: Cardiovascular Quality and Outcomes. 2017;10(2):e003497. doi:10.1161/CIRCOUTCOMES.116.003497
- Trost S, Beauregard J, Chandra G, et al. Pregnancy-Related Deaths: Data from Maternal Mortality Review Committees in 36 US States, 2017-2019.