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Pregnant Women Need Routine Blood Pressure Checks

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Pregnant women should get their blood pressure checked at each prenatal visit to screen for preeclampsia, a potentially fatal complication that can damage the kidneys, liver, eyes and brain, new U.S. guidelines say.

While many doctors already monitor blood pressure throughout pregnancy, the U.S. Preventive Services Task Force (USPSTF) updated its guidelines for the first time since 1996 to stress that screening at every visit can help doctors catch and treat preeclampsia before it escalates from a mild problem to a life-threatening one.

“Preeclampsia is one of the most serious health problems affecting pregnant women,” task force member Dr. Maureen Phipps, a women’s health researcher at Brown University in Providence, Rhode Island, said by email.

“Because this condition is common and critical, the Task Force offers two separate recommendations to help women lower the risk associated with preeclampsia – screening for preeclampsia is recommended for all pregnant women, and women at high risk of developing the condition can take low-dose aspirin to help prevent it,” Phipps added by email.

The screening recommendations, published on Tuesday in JAMA, apply to women without a history of preeclampsia or high blood pressure. Separate guidelines advise low-dose aspirin after the first 12 weeks of pregnancy for women with a history of elevated blood pressure. (bit.ly/2oIwP5B)

Preeclampsia can progress quickly, and typically develops after 20 weeks of pregnancy. Blood pressure screening earlier in pregnancy can show normal results for women who go on to develop preeclampsia.

In addition to elevated blood pressure, women with preeclampsia may also have excess amounts of protein in their urine, as well as swelling in the feet, legs and hands.

Women may suffer from stroke, seizures, organ failure and in rare cases, death. For babies, complications include slower growth inside the uterus, low birth weight and death.

Risks for preeclampsia include a history of obesity, diabetes, kidney disease, lupus or rheumatoid arthritis, as well as a mother or sister who has experienced the condition.

Because the risks of preeclampsia increase with age, women may be able to lower their chances of developing this complication by having babies sooner, said Dr. Dana Gossett, an obstetrics and gynecology researcher at the University of California, San Francisco, and co-author of an accompanying editorial in JAMA.

“Beyond that, it is also important to ensure that all health problems are well managed prior to pregnancy,” Gossett said by email. “High blood pressure should be under good control, other diseases like kidney disease or lupus should be well controlled, and women should try to be close to their ideal body weight prior to conception.”

Checking blood pressure at every prenatal visit can help prevent complications for mothers and babies alike, said Dr. Martha Gulati, chief of cardiology at the University of Arizona College of Medicine in Phoenix and author of a separate editorial in JAMA Cardiology.

“This is something that should be provided to every woman as part of preventive care,” Gulati said by email. “We will save lives and prevent complications and death in pregnant women with this simple, cost-effective” test that doesn’t take much time.

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Dr. Alex Jimenez DC, MSACP, CIFM*, IFMCP*, ATN*, CCST
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