Maternal deaths caused by chronic hypertension continue to rise

More women die giving birth in the US than in any developed country. That alone makes this study important.

Increasing chronic hypertension (high blood pressure) is contributing substantially to the excessive maternal death rate. Black women are particularly at risk, according to new research.

The extensive study, published in Hypertension, analyzed data from more than 155 million births and 3,287 hypertension-related maternal deaths among women aged 15 to 49 from 1979 to 2018 in the United States. The study showed a 15-fold increase in maternal mortality rates associated with chronic hypertension over the 40-year period.

What the researchers say: “Overall hypertension-associated deaths declined in the U.S. over the last 40 years, but if you isolate the data on women who have chronic hypertension, which is defined as a pre-existing hypertensive condition or hypertension diagnosed within the first 20 weeks of pregnancy, as a cause, mortality rates have increased quite substantially—on average, by about 9.2 percent per year over the last 40 years. So, it is the chronic hypertension that has really driven the maternal mortality trends in the U.S. over the last 40 years,” said the study’s lead author.

The incidence of hypertension-related maternal deaths sharply increased with maternal age, being highest among women aged 45 to 49, and obesity, the study found. The researchers also uncovered a substantial race disparity in the trends of maternal mortality rates due to hypertensive conditions.

“Black women were at anywhere from three- to four-fold increased risk of dying from a hypertension-related cause compared to white women in the United States, and this disparity has persisted for the last 40 years,” the researchers said, noting that problems with access to care and many risk factors for hypertensive complications are higher among Black women than white women, which contributes to this disparity.

Strategies are needed to reduce hypertension-related maternal deaths by focusing improvements in such areas as advanced maternal age, obesity, and racial inequities in care—issues deserving “urgent public health attention,” the researchers said. The findings also underscore the need to better identify and treat women with chronic hypertension and develop targeted prenatal interventions, including tight blood pressure control and efforts to reduce body mass index, they said.

However, as well as treating the problem with drugs, hypertensive complications might also be reduced by focusing on lifestyle choices—particularly smoking, alcohol, weight, and a balanced diet—both before pregnancy and early in pregnancy, the lead author noted. The study findings have implications for clinical providers as well, he said, noting most maternal deaths occur within the first six weeks (42 days) after pregnancy.

“Women who have any obstetrical complications, particularly hypertension-related complications, should be monitored very closely during the course of pregnancy and delivery, as well as in the postpartum period. Following these women after pregnancy is crucial,” he stressed.

The researchers believe the implementation of “obstetrics bundles” for high-risk conditions should be more widespread, implemented in all hospitals. “These bundles set the stage for identification, treatment and prevention of various obstetrical complications, including hypertension, and their effectiveness has been well documented in several studies, including those in New York, as well as in California,” they said.

“Women are starting their families when they are older and they may be heavier and in a poorer state of health,” the researchers explained. “For a portion of the time period studied, the CDC reported that the percentage of first births to women between 30 and 34 rose by 28 percent, and those for women 35 and older rose 23 percent. To help reduce hypertension-related deaths in these groups, we all need to work to ensure women are in optimal health before they start their families. The four-fold increased risk for mortality in Black compared with white women is especially concerning, and special attention needs to be focused to eliminate this disparity.”

So, what? Overall, the poorer you are the worse in terms of your access to good medical care. That’s true the world over. There’s also a deeper inequality issue at work here. Obesity is a cause of hypertension and there have been a lot of studies—many reported over the years in TR—which have shown that those on lower incomes can’t afford or don’t have the time or the physical capacity to cook or buy nutritious food. They are forced to consume foods that are cheap and drenched in fat, salt and sugar.

There is a simple and very good guide to hypertension published by the Australian government which is well worth the read. It lists the causes of high blood pressure thus:

• leading a sedentary lifestyle (with little or no exercise)
• smoking
• being overweight
• a diet with a high salt intake
• high blood cholesterol
• a family history of high blood pressure
• high alcohol consumption
• diabetes