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The Recentine Cohort Study Analyzed 263,518 Pregnant Patients Without Pre -Existing Heart, Kidney, Or Liver Disease to Asses The Risk of Severe Maternal Morbidity (SMM) Based on Chronic Hypertension and Hypertensive Disorders During Pregnacy. The Study, Which was published online in Jama Network Open, FOUND THAT PRECLAMPSIA DEVELOPED IN 31.5% OF PATIES WITH CHRONIC HYPERTENSION AND 4.7% OF THOSE WITHHOUT IT. Risk Was Nearly Five Times Higher for Chronic Hypertension with Superimposed Suchlessa and Comblampsia Alone, Nearly Twice As High For Gestational Hypertension, and Only Slightly Elevated for Chronic HyPertension Without Lowest-Risk Group.
Physician’s Weekly (PW) Spoke with Lead Author Erica P. Gunderson, PhD, MPH, Division of Research, Permanent Kaiser, To Better Understendo Suchless Significantly SMM Risk, Regardless of Chronic Hypertension Status, and Highlights The Need for Targeted Prenatal Monitoring and Prevention Strategies.
PW: Given That Inteclampsia, WHETHER WITH OR ORTHOUT CHRONIC HYPERTENSION, WAS ASSOCIATED WITH HIGH SMM RATES, How Should Physicians Adjust Their Prenatal Monitoring Strategies for Patients Who Are At Risk?
Dr. Gunderson: This Study Set Out to Advance The Research On Severe Matenial Morbidity By Designing This Study To Determine Better How Pregnancy Affects This Office and How the Type of Hypertension When Occurs AFFECTS The Risk of Women.
WE SET OUT TO SEPARATE PREXISTING CHRONIC DISEASES, SUCH THE CARDIOVASCULAR DISEASE AND KIDNEY DISEASE BEFORE PREGNANCY, FROMO CARE CONDITIONS AND COMPLICATIONS DURING PREGNANCY THIS CONSTRUCTION TO THIS RISK. Previous Studies Did Not Differentiate The Different Risk Levels in Women.
These Adverse Outcomes Can Occur in Women with Chronic Hypertension and Without Chronic Hypertension, But We Wanted to Determine The Risk For Women Who Are Unencumbered By These Pre -Existing Chronic Diseases. Secondly, in Terms of When Hypertension Occurs in Women, We Wanted to Understand the Joint Effects of Preprency, Chronic Hypertension, and Hypertensive Disorders That Development Pregnancy and In Terms of How That That Severe Maternal Morbidity.
This Study Takes A Different Approach from Previous Studies and Levels The Risk Factor Contributions in Looking at the Impact of Chronic Hypertension and WHETH WOMEN DEVELOP A HYPERTENSIVE DURING PREGNATY. The Audience Probably Knows That Hypertensive Disorders of Pregnancy Are the Strongest Risk Factors for Maternal Morbidity and Mortality, and They Disprortionity Affect Black Women.
We Know That Inteclampsia is the Strongest Risk Factor for Having Severe Maternal Morbidity, Which Can Be Stroke, Heart Failure, Myocardial Infarction, Heart Attack, and Renal Failure, Which Are Serious Life-Threatning Condions.
What can we do to Evaluate Risk Better in Terms of Targeted Prevention?
We know that these pre -existing conditions occur at low rates, but that group with thhose conditions is always at Higher risk of adverse perinatal outcomes and severe morbidity. But what is the risk for women who have chronic hypertension? That affects about 5% of all pregnant Women, and for Those with Chronic Hypertension Entering Pregnancy, About One In Three Development Preclampsia, Whereas for Women Who Don’t Chronic Hypertension, About One In 20 of Those Pats Develop Suchless. The Study Showed That There Were Patients Who Developed Inteclampsia with or Without Chronic Hypertension Had the Same Fivefold Higher Increured Risk. That’s an interesting question BECAUSE We have Two Different Types of Patients With Different Risk Conditions. One has a Much Higher Occurrence of This Very Severe Outcome.
How can Physicians Monitor and Development Prevention Strategies for These Different Risk Factors?
IT’S IMPORTANT TO DEVELOP INTERVENTIONS, AND THE CHARACTERISTICS BEFORE PREGNATINCY CAN HELP PHYSICIns Determine Risk Strata, Which Patients They Should Evaluate More Closely, and Which Risk Factors. We Know that innsiclampsia is Very Difficult to Prevent. Interventions are Being Developed, But We Have Limited Information on That. Some have suggested lifestyle, and that goes for all patients, but specially patients with Chronic Hypertension Should Ask Many questions About the Management Strategy and How to Adjust. PRENATAL MONITORING IS AN IMPORTANT ASPECT FOR FUTURE Research, But Current Management. What We Found in This Study, Which I Think is crucial to Understand and Which Had Not Been Reported Before, is that Women with Chronic Hypertension Who Did Not Development Had a risk of maternal Morbidity That Was Nearly The Same As Witen Whit Chronic Hypertension and No Hypertension That Developed During Pregnancy.
This was a very important Finding in the Study That Avoidance and Prevention of Comblampsia Cour Lower Risk for Patients with Chronic Hypertension similar, comparable leads to thhose who didn’t Start pregnancy with chronic hypertension. That focuses the lens on Strategies to Prevent these Hypertensive Disorders of Pregnancy and All Women, but specially those with chronic hypertension.
The Study Found That Patients with Uncomplicated Chronic Hypertension Had Smm Similar Rates To Those Without. How does that influence decisions Regarding Earlier Intervention and Treatment?
I THINK THINK IF YOU WANT TO, FOR ALL PREGNANT WOMEN, PRE-PREGNANCY RISK FACTOR ASSESSMENT AND PRE-PREGNATINCY PREPARATION FOR CONCEPTION ARE CRUBIAL. There are also Recommendations for All Women to Assess Cardiovascular Health, For Example, Before They Become Pregnant. Trying to get in the best physiologic risk avoidance level possible be a laudable goal for all pregnant women, and particularly anyone with a pre -existing condition such the diabetes or chronic hypertension or even higher than desirable body weight weight would warmment Some Lifestyle Changes Such as Physical Activity, Sleep, Healthy Diet and Stress Reduction, and Any Avoidance of other Challenges in Their Lives. Try to Ameliorate Any Risk Factors by Consulting Their Primary Care Provider Physician Before Becoming Pregnant to Try to Be In Optimal Health to Avoid The Complications of Pregnancy As Well as the Severe Morbidity of Delivery Outcomes.
With Chronic Hypertension Becoming More PREVALENT SOON PAIENTS WHAT ARE PREGNANT, How CAN Physicians Balance The Need for Targeted Screening and Intervention Without Over Medicalizing Pregnancy In That Low-Risk Population?
The Recommendations have Been Out there from the cdc and other professional organizations for women with chronic conditions or chronic dissees before pregnancy to participate in pre-pregnancy healthcare and intensive healthcare to control thhose dissees optimally control blood pressur, fine-tune medication, Pharmacologic Treatment If’s Appropriate for Their Conditions. They Should Work with Their Primary Care Provider and Team to Prepare and Achieve the Best Control of Their Condition Before Conception. Now, that takes planning. Planning is some difficult, but if we can implement programms in the healthcare systems that Specifically Address Some of These Sets, Special for Patients with Chronic Conditions Predating PREGNATCY, We Could Go Further on What Those Interventions Should Be Exactly Individualized, and i Think per patch risk. We’re Working Very Hard on Development Models and Prediction Models That Look at Various Clinical Risk Factors Like Blood Pressure; Even in Women who are not recognized or diagnosed with Hypertension who are with the normal Blood Pressure Range, thhose risks associated with adverse Outcomes or with Development of Hypertensive Disorders can be evaluated more close.
We’re Working on Very Applications to the Real World to Evaluate Risk and Try To Determine Those Patients in the Low-Risk Category That May Also Need AddiThone Monitoring. There’s a Balance of Trying to Use Data and Our Data Systems To Get Quantitative and Better Targeted Risk Evaluation with Screening. Then, Screening Can Take Potentially Basic Information About Weight, Blood Pressure, and Oter Biochemical Measures That All Pregnant Women Receive. But I Think How we use that information and how often we need it are Things Yet to determining how that it best serves the cats and what interventions will be effect to prevent morbidity and complications of pregnancy.
