The American Heart Association recently released a scientific statement concerning hypertension in pregnancy, which laid out the variety of disorders, the epidemiology, the future impact of pregnant persons, and the current debates regarding treatment and diagnosis.
This statement addresses all stages from preconception through post pregnancy and outlines the many prevention and treatment options available. Although family physicians were not specifically called out to be partners in the statement, we have a large role to play for both our pregnant patients and those of reproductive age who are not pregnant.
Dr. Santina J.G. Wheat
Preconception health
One of the first things pointed out was preconception health. Regardless of whether each individual family physician provides prenatal care, we can all focus on preconception health for those of reproductive age.
The statement from the AHA points out that “lifestyle changes before and during pregnancy may ameliorate both maternal and fetal risks.”
As many already do, family physicians should focus on encouraging their patients to practice healthy eating and exercise prior to pregnancy to help establish routines that will decrease the risk of hypertensive disorders in pregnancy.
Focusing on care prior to pregnancy also allows the primary care provider to be involved in quickly linking patients to prenatal care, as it is well established that early and complete prenatal care is important for improving outcomes.
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Later-in-life pregnancy
The AHA also highlights that many are choosing to have pregnancies at older ages and with greater comorbidities than in past years. This is another area in which family physicians can provide important care.
We can help by first identifying the chronic conditions, such as hypertension and diabetes, that make the hypertensive disorders of pregnancy more likely. We should then focus on the treatment of these conditions during the preconception time so that they are well controlled prior to pregnancy.
We should also preferentially choose medications that our patients will be able to continue in pregnancy, so that control may be maintained throughout pregnancy.
The statement particularly highlights the avoidance of antihypertensives that are renin-angiotensin system blockers.
We can also help prepare our patients for the additional medications, testing, and precautions they will likely require during their pregnancy so that they know what to expect.
Family physicians are also already starting to utilize home blood pressure monitoring and can introduce this method so that patients may continue to monitor their blood pressures during pregnancy.
Throughout pregnancy, the new statement calls in the current debates of when prenatal care providers should be diagnosing hypertensive disorders and the goals of treatment.
Prenatal care providers can use shared decision-making for medication choices and blood pressure goals. They can also continue to encourage the healthy lifestyle choices such as diet and exercise to reduce the risk of poor outcomes.
This AHA also indicates that prenatal care providers can integrate the use of home blood pressure monitoring as they monitor the blood pressure for patients with hypertensive disorders of pregnancy.