A New Solution for Hypertension in Pregnancy?

The medical field has long assumed that clinicians can’t do much about high blood pressure during and after pregnancy, but a new study in the Journal of the American Medical Association suggests otherwise. In the study, Jamie Kitt, DPhil, and colleagues were able to meaningfully reduce the blood pressure of pregnant and postpartum patients using a self-managed, physician-guided system.
Hypertension in Pregnancy Is a Leading Cause of Infant Mortality
Before getting into the details of the study, it’s important to highlight why clinicians care so much about high blood pressure – also known as hypertension – in pregnant and postpartum patients. When pregnant people experience high blood pressure, it can lead to a few complications for the mother and/or the baby. For the mother, high blood pressure can cause strokes, preeclampsia, eclampsia, placental abruption (placenta separating from uterine wall), or the need for induced labor. For the baby, it can lead to preterm delivery (birth before 37 weeks of pregnancy) and a low birth weight (less than 5 pounds, 8 ounces), which are two of the leading causes of infant mortality in the U.S. According to Sandra Taler, MD, from the Mayo Clinic: “It's become increasingly known that women who have hypertension and pregnancy are at risk of later complications. So, whatever we can do to reduce those complications is also a big deal.”
In addition to being potentially life-threatening, maternal high blood pressure is unfortunately quite common. According to the CDC, hypertension occurs in 1 in every 12 to 17 pregnancies for mothers ages 20 to 44 and is on the rise.
Remote Blood Pressure Monitoring Shows Promising Results
Setting out to address this widespread issue, the researchers in this study designed a program wherein patients in the intervention group took their own blood pressure measurements daily, or twice per day if abnormal, using the Omron Evolv (a wireless, Bluetooth-enabled blood pressure cuff) and uploaded the data to a smartphone app. Based on the advice of a clinician in the research study, the patient’s app then instructed them to increase, decrease, or maintain their current medication dosing. This program involves much more data-gathering and clinician input than the standard of care, which is generally only a blood pressure review at 7 to 10 days after giving birth and a doctor visit after 6 to 8 weeks.
Through these interventions, the study lowered the average 24-hour ambulatory blood pressure by 6.5/5.8 mm Hg, as compared with the blood pressure under usual care after 9 months post-delivery. The intervention also reduced the number of readmissions to the hospital post-delivery due to hypertension from 29 to 8 cases. What was most striking – according to Angela Burgess, MD, a University of Texas Health Science Center maternal-fetal medicine physician – was that, despite many participants no longer taking their antihypertensive medication, the intervention group still had lower blood pressure. In each group, medication persistence at 6 weeks postpartum was about 30%. That number dropped to about 12% by the office visit between 6 to 9 months postpartum.
The study, which enrolled participants between February 2020 and November 2021, ultimately included 220 pregnant patients over the age of 18, with an average age of 32.6. However, as the researchers noted, one of the primary limitations to the study was the lack of diversity; most participants were white and relatively young. Researchers were concerned that the required use of technology could have ruled out older and poorer participants, so they are advocating for future research to see if a more diverse intervention group shows similar results.
Contact The Eisen Law Firm for Assistance with Hypertension-related Negligence
While medical improvements like the intervention in this study could reduce the rate of hypertension-related complications during and after childbirth, for now the risk of high blood pressure in birth remains. If you or a loved one suffered harm during or after childbirth, we may be able to help. Reach out today to schedule a free initial consultation and case review with one of our Cleveland birth injury attorneys. Call us at 216-687-0900, or contact us online to set up a time to connect.