Rising Pregnancy Hypertension

Sara McGinnis, nine months pregnant with her second child, felt something was wrong. Her body was swollen, she was tired and dizzy, and her symptoms worsened. Despite telling her doctor and nurses, and even going to the emergency room, she was dismissed with the response: “It’s summertime and you’re pregnant.” Two days later, Sara suffered a massive stroke followed by a seizure on the way to the hospital, where she was heading due to a splitting headache. She never met her son, Owen, who survived through an emergency delivery, but died the day after his birth. Sara had eclampsia, a stroke in pregnancy caused by persistent high blood pressure, also known as hypertension.

High blood pressure during pregnancy is becoming increasingly common, with rates roughly doubling since 2007. While increased testing contributes to this rise, data shows the overall maternal mortality rate is also climbing, with high blood pressure being a leading cause. Experts are working to address this crisis, with the American College of Obstetricians and Gynecologists lowering the threshold for treating pregnant and postpartum patients for high blood pressure in 2022. Federal agencies offer training in best practices for screening and care, and data from Alaska and West Virginia shows a decline in maternal deaths from high blood pressure after implementing these guidelines. However, applying these standards to everyday care takes time, and hospitals are still striving to incorporate practices that could have saved lives like Sara's.

Mary Collins, 31, of Helena, Mont., developed high blood pressure during her pregnancy this year. Despite being active and seemingly healthy, she experienced sluggishness, rapid weight gain, and slowed fetal growth. After initially being told everything was fine, Collins was diagnosed with preeclampsia after she brought her symptoms to her obstetrician's attention. She was airlifted to Missoula, Mont., for delivery, and her daughter, Rory, was born two months early. Both Rory, now about 3 months old, and Collins are still recovering from the ordeal.

The typical cure for preeclampsia is delivering the baby. While medication can help prevent seizures and speed up fetal growth, preeclampsia can also develop soon after delivery, a condition that researchers still don't fully understand. Wanda Nicholson, chair of the U.S. Preventive Services Task Force, emphasizes the need for steady monitoring during and after pregnancy, as blood pressure can fluctuate rapidly and symptoms can be subtle.

Despite years of federal efforts to improve birth safety, hospitals are still struggling to match screening and treatment for preeclampsia with best practices. The Montana Perinatal Quality Collaborative spent a year providing high blood pressure training to hospitals across the state, revealing that doctors' use of treatment plans for high blood pressure in pregnancy was inconsistent. Even how nurses checked pregnant patients' blood pressure varied. To address this, Bozeman Health is tracking treatment with the goal that any pregnant person with high blood pressure receives appropriate care within an hour. Katlin Tonkin, a nurse who lost her son Dawson to preeclampsia in 2018, is one of many advocating for better implementation of evidence-based practices to prevent such tragedies from happening again.