Hypertensive disorders of pregnancy and long-term risk of hypertension: what do Ontario prenatal care providers know, and what do they communicate? (original) (raw)
Related papers
Obstetrics & Gynecology, 2022
Objective:To describe clinician screening practices for prior hypertensive disorders of pregnancy (HDP), knowledge of future risks associated with HDP, barriers and facilitators to referrals for cardiovascular disease risk evaluation in women with prior HDP, and variation by clinician- and practice-level characteristics.Methods:We used data from Fall DocStyles 2020, a cross-sectional, web-based panel survey of currently practicing US clinicians. Of 2,231 primary care physicians, obstetrician–gynecologists, nurse practitioners, and physician assistants invited to participate, 67.3% (n=1,502) completed the survey. We calculated the prevalence of screening, knowledge of future risks, and barriers and facilitators to referrals, and assessed differences by clinician type using Chi-square tests. We evaluated associations between clinician- and practice-level characteristics and not screening using a multivariable log-binomial model.Results:Overall, 73.6% of clinicians screened patients for a history of HDP; obstetrician–gynecologists reported the highest rate of screening (94.8%). Overall, 24.8% of clinicians correctly identified all cardiovascular risks associated with HDP listed in the survey. Lack of patient follow-through (51.5%) and patient refusal (33.6%) were the most frequently cited barriers to referral. More referral options (42.9%), patient education materials (36.2%), and professional guidelines (34.1%) were the most frequently cited resources needed to facilitate referrals. In the multivariable model, primary care physicians and nurse practitioners and physician assistant were more likely than obstetrician–gynecologists to report not screening (adjusted prevalence ratio [aPR] 5.54, 95% Confidence Interval [CI]: 3.24, 9.50 and aPR 7.42, 95% CI: 4.27, 12.88, respectively). Clinicians seeing <80 patients per week (aPR 1.81, 95%CI: 1.43, 2.28) were more likely to not screen relative to those seeing ≥110 patients per week.Conclusion:Three-quarters of clinicians reported screening for a history of hypertensive disorders of pregnancy; however, only 1 out of 4 clinicians correctly identified all of the cardiovascular risks associated with HDP listed in the survey.
Hypertension in Pregnancy, 2004
Background: How Canadian practitioners are diagnosing and managing the hypertensive disorders of pregnancy (HDP), particularly in relation to the 1997 recommendations published by the Canadian Hypertension Society (CHS), is not known. Methods: A survey, with French and English versions (and covering diagnosis, evaluation, and management of pregnancy hypertension), was mailed to all (N = 1757, including obstetricians, family doctors practicing obstetrics, and midwives). Additionally, internists [i.e., all nephrologists (N = 191) and a random sample of 25% of general internists (N = 450)] registered with the Royal College of Physicians and Surgeons of Canada were sampled. The survey was distributed in two mailings and one reminder card. Data were entered into Microsoft Access, and Graph Pad Prism used to summarize responses [N (%)]. Differences in practice between specialties were examined, with a Bonferonni correction used to calculate a significant p value based on the number of comparisons and alpha of 0.05. Results: Respondents numbered 1187 (49.5%), with 466 not informative for the purpose of the study (due to retirement, or practices that do not include pregnant women with hypertension). The final analysis included 721 completed surveys. Most (609, 84.5% of) respondents take blood pressure (BP) with women in the sitting position, and use a mercury sphygmomanometer (79%) and the 5 th Korotkoff (61%) sound to designate diastolic BP (dBP). To monitor pregnancies complicated by preeclampsia, most clinicians use the proposed laboratory tests of maternal well-being (usually at least once/week), fetal well-being [nonstress test (NST, at least once/week), and ultrasonographic studies (once weekly to every two weeks)]. There is general agreement that women with preeclampsia should be delivered for uncontrolled hypertension, end-organ dysfunction, or fetal compromise (nonreassuring NST, severe oligohydramnios, biophysical profile < 4, estimated fetal weight < 5 th centile, and reversed end-diastolic flow by umbilical artery Doppler velocimetry). Less consensus was seen for delivery for preeclampsia at > 34 weeks, mild asymptomatic HELLP syndrome, hyperreflexia, and absent end-diastolic flow by umbilical artery Doppler velocimetry. Interpretation: This survey has clarified the current state of practice with respect to the diagnosis and evaluation of women with all types of HDP. In particular, we have identified areas of potential variability in BP measurement, and provided data on the feasibility of enrolling women with sub types of preeclampsia into intervention studies aimed at prolonging pregnancy.
Knowledge of Midwives as a Healthcare Provider About Hypertensive Disorders During Pregnancy
Indonesian Journal of Obstetrics and Gynecology, 2019
Objective : To investigate the knowledge of midwives about hypertensive disorders during pregnancy. Methods : We used a cross-sectional study design by evaluating the knowledge of midwives regarding hypertensive disorders during pregnancy by using a questionnaire. This study was conducted in Jakarta during the period between September and October 2017. The subject is a midwife member of Indonesian Midwives Association (IBI) practicing in DKI Jakarta, Indonesia. Results : Total respondents were 639 practicing midwives in Central, South, West and North Jakarta. A total of 323 (50.5%) of the respondents had a suffi cient level of knowledge about the basic science of high blood pressure in pregnancy, 372 (58.2%) of respondents had a good level of knowledge related to clinical examination and early diagnosis of high blood pressure in pregnancy, and 385 (60.3%) of respondents had a good level of knowledge about the management of high blood pressure in pregnancy.The location of the clinic, physician attendance, the number of patients treated by the midwives, and the number of midwives attending the clinic had a signifi cant association with the knowledge level of the subjects (all P values < 0,05) Conclusions : The lowest knowledge level was about the basic science of hypertensive disorders during pregnancy. Factors affecting the knowledge levels of the midwives were the location of the clinic, physician attendance, the number of patients treated by the midwives, and the number of midwives attending the clinic
Women's Health Reports
Background: Preeclampsia, a condition in pregnancy characterized by new onset high blood pressure and proteinuria, complicates 2%-8% of pregnancies globally. Early detection, careful monitoring, and treatment of high blood pressure are crucial in preventing mortality related to preeclampsia disorders. There is limited data that examines obstetric/gynecologic (OBGYN) provider-type practices concerning management of hypertensive disorders of pregnancy to reduce early onset preeclampsia (EOP). We assessed the knowledge and practice patterns of OBGYN management to reduce EOP. Methods: We conducted a semistructured survey with OBGYN residents, maternal-fetal medicine fellows, and attending physicians (OBGYN and family medicine) at a single academic medical center to assess the management of hypertensive disorders to EOP. Results: Thirty-one participants (71% residents/fellows 29% attendings) completed the survey. Seventy-eight percent of attendings indicated they discuss blood pressure and preeclampsia with all patients compared to 50% of residents/fellows (p = 0.31). Eighty-nine percent of attendings reported they are extremely likely to monitor high-risk patients compared to 36% of residents/fellows (p = 0.07). Conclusion: Attending physicians were more likely to appropriately manage hypertension in women at risk for pregnancy compared to residents/fellows. Further research is needed on monitoring high-risk patients.
Journal of Human Hypertension, 2013
Hypertensive disorder of pregnancy (HDP) is considered an important determinant in the prediction of future hypertension. The aim of this study is to examine whether HDP improves prediction of future hypertension, over prediction based on established risk factors measured during pregnancy. We used a community based cohort study of 2117 women who received antenatal care at a major hospital in Brisbane between 1981 and 1983 and had blood pressure assessed 21 years after the index pregnancy. Of these 2117 women, 193 (9.0%) experienced HDP and 345 (16.3%) had hypertension at 21 years postpartum. For women with HDP, the odds of being hypertensive at 21 years postpartum were 2.46 (95% CI 1.70, 3.56), adjusted for established risk factors including age, education, race, alcohol, cigarettes, exercise and body mass index. Addition of HDP did not improve the prediction model that included these established risk factors, with the area under the curve of receiver operator (AUROC) increasing from 0.710 to 0.716 (P-value for difference in AUROC ¼ 0.185). Our findings suggest that HDP is strongly and independently associated with future hypertension, and women who experience this condition should be counselled regarding lifestyle modification and careful ongoing blood pressure monitoring. However, the development of HDP during pregnancy does not improve our capacity to predict future hypertension, over risk factors identifiable at the time of pregnancy. This suggests that counseling regarding lifestyle modification and ongoing blood pressure monitoring might reasonably be provided to all pregnant and postpartum women with identifiable risk factors for future hypertension.
Experiences of women with hypertensive disorders of pregnancy: a scoping review
BMC Pregnancy and Childbirth
Background Hypertensive disorders of pregnancy (HDP) constitute one of the leading causes of maternal and perinatal mortality worldwide, and are associated with an increased risk of recurrence and future cardiovascular disease. HDP affect women’s health condition, mode of birth and timing, length of hospital stay, and relationship with their newborn and family, with future life repercussions. Aims To explore the experiences of women with HDP from pregnancy to postpartum, and to identify (a) their perceptions and understanding of HDP, (b) their understanding of future health risks, and (c) the possible interventions by healthcare providers. Methods A scoping review was conducted following the Joanna Briggs Institute method and in accordance with the PRISMA-ScR checklist. The following databases were searched from 1990 to 2020 (October): MEDLINE (PubMed), EMBASE, Cochrane Library, CINAHL, PsycINFO, and Google Scholar database. The Critical Appraisal Skills Programme (CASP) checklist w...
Pregnancy Hypertension, 2018
In pregnant women with previous gestational hypertension: to compare the prevalence of preeclampsia as defined by the 2001 versus the 2014 International Society for the Study of Hypertension in Pregnancy (ISSHP) criteria, to determine the rates of fetal growth restriction (FGR) as defined, not only by birthweight centile, but in combination with fetal ultrasound studies and, finally, to determine rates of other related outcomes such as gestational diabetes (GDM) and obstetric cholestasis (OC). Study design: This was a retrospective observational study based at the Antenatal Hypertension Clinic, Kings College Hospital, London. Routinely collected data of 773 women booked between 2011 and 2016 with a history of gestational hypertension was analysed. All women were normotensive at booking and those with chronic hypertension were excluded. Main outcomes measures: Hypertensive disorders of pregnancy (ISSHP-2014), FGR, GDM. Results: Forty-nine percent developed one or more pregnancy complications, of which 72% were hypertensive disorders of pregnancy, 25.8% preeclampsia, 25% GDM and 19% FGR. Overall recurrence rate of preeclampsia was 12.5% (ISSHP-2014). Higher blood pressure and body mass index at booking were associated with higher risk of preeclampsia and GDM. Earlier gestation of previous hypertension was associated with higher risk of preeclampsia and FGR. The ISSHP-2014 compared to the 2001 guidelines classified 56% more women as having preeclampsia. Conclusion: Pregnant women with a history of gestational hypertension have a 49% chance of developing a complication related to a hypertensive disorder, GDM and OC. The rate of preeclampsia was more than doubled if the updated ISSHP-2014 definition was used.
PRENATAL CARE AND HYPERTENSIVE DISORDERS DURING PREGNANCY: A CROSS-SECTIONAL STUDY (Atena Editora)
PRENATAL CARE AND HYPERTENSIVE DISORDERS DURING PREGNANCY: A CROSS-SECTIONAL STUDY (Atena Editora), 2024
Introducción: Los trastornos hipertensivos durante el embarazo constituyen un importante problema de salud pública que afecta a mujeres embarazadas en todo el mundo, siendo más común en los países en desarrollo. Esta condición no solo tiene consecuencias para la salud de la madre durante el embarazo y el posparto, sino que también impone un aumento de costos en la atención obstétrica y neonatal, lo que la convierte en un problema tanto económico como social. Objetivo: Determinar el efecto de los controles prenatales en pacientes puérperas que presentaron trastornos hipertensivos durante su embarazo en el Hospital Especializado Matilde Hidalgo de Procel en el periodo de mayo - agosto 2022. Material y método: El diseño de la investigación es de carácter no experimental, observacional – transversal. Conclusión: La realización de controles prenatales no disminuye las complicaciones en embarazadas con trastornos hipertensivos.
JAMA Network Open, 2021
IMPORTANCE Hypertensive disorders of pregnancy are a leading cause of maternal morbidity and mortality. The impact of applying recent guideline definitions for nonpregnant adults to pregnant women is unclear. OBJECTIVE To determine whether reclassification of hypertensive status using the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guideline definition better identifies women at risk for preeclampsia or eclampsia and adverse fetal/neonatal events compared with the current American College of Obstetricians and Gynecologists (ACOG) definition of hypertension. DESIGN, SETTING, AND PARTICIPANTS This cohort study used electronic medical record data of women who delivered singleton infants between 2009 and 2014 at a large US regional health system. Data analysis was performed from July 2020 to September 2020. EXPOSURE Application of ACC/AHA and ACOG guidelines for the definition of chronic and gestational hypertension. MAIN OUTCOMES AND MEASURES The primary maternal end point was the development of preeclampsia or eclampsia, and the primary fetal/neonatal end point was a composite of preterm birth, small for gestational age, and neonatal intensive care unit admission within 28 days of delivery. Net reclassification indices were calculated to examine how well the lower ACC/AHA diagnostic threshold reclassifies outcomes of pregnancy compared with the current ACOG definition of hypertension. RESULTS Applying the ACC/AHA criteria to 137 389 pregnancies of women (mean [SD] age at time of delivery, 30.1 [5.8] years) resulted in a 14.3% prevalence of chronic hypertension (19 621 pregnancies) and a 13.8% prevalence of gestational hypertension (18 998 pregnancies). A 17.8% absolute increase was found in the overall prevalence of hypertension from 10.3% to 28.1%. The 2.1% of women who were reclassified with chronic rather than gestational hypertension had the highest risk of developing preeclampsia compared with women without hypertension by either criterion (adjusted risk ratio, 13.58; 95% CI, 12.49-14.77). Overall, the use of the ACC/AHA criteria to diagnose hypertension resulted in a 20.8% improvement in the appropriate identification of future preeclampsia, but only a 3.8% improvement of appropriate fetal/neonatal risk classification. CONCLUSIONS AND RELEVANCE Using the lower diagnostic threshold for hypertension recommended in the 2017 ACC/AHA guideline increased the prevalence of chronic and gestational hypertension, markedly improved the appropriate identification of women who would go on to (continued) Key Points Question How does the prevalence of hypertension in pregnant women change when using the 2017 American College of Cardiology/American Heart Association definition, which is lower than the American College of Obstetricians and Gynecologists threshold, and is there an association with maternal or fetal outcomes? Findings In this cohort study that included 137 389 pregnancies, the prevalence of hypertension increased from 10.3% to 28.1% and resulted in a net reclassification index of 20.8% for the identification of future preeclampsia and 3.8% for the identification of fetal/ neonatal adverse events. Meaning These findings suggest that applying the lower diagnostic thresholds to pregnant women may better identify women at risk of adverse events.