Every 11 Minutes: Hypertensive Disorders in Pregnancy Are Deadly (and Have Long-Term Consequences for Mothers and Children)

By: Rebecca Lorenzen, Wilson Center

“Hypertensive disorders in pregnancy are responsible for over 76,000 maternal deaths globally, killing a woman every 11 minutes,” said Charlotte Warren, Senior Associate at the Population Council, at a recent Wilson Center event about non-communicable diseases in pregnancy, held on World Preeclampsia Day.  These disorders complicate 8 to 10% of pregnancies worldwide and are trending upward due to increased maternal weight and sedentary lifestyles. “In low-income countries, a woman has approximately 300 times higher risk of dying of preeclampsia and eclampsia than a woman in a high-income country,” she said.

Preeclampsia leads to a higher risk of future heart disease, including stroke, high blood pressure, ischemic heart disease, then gestational hypertension, said Dr. Tabassum Firoz, a clinician-researcher in Internal Medicine and Obstetric Medicine at Yale New Haven Health. “If a woman develops preeclampsia before 37 weeks, some studies have shown that they will have a sevenfold increase in their risk of heart disease.” Screening for preeclampsia should also take into account “the barriers that women face, both in low and high-income countries…such as time, cost, a lack of knowledge about what has actually happened to them in pregnancy, and the physiologic and psychological recovery.”

Preeclampsia affects not only women but also their children, as “preeclampsia is a major underlying cause of late fetal and early neo-natal deaths…amounting to 1,600 lives lost every day,” said Warren. “Babies born to mothers with preeclampsia may be pre-term, low birth-weight, [and] small for gestational age—all factors that carry an increased risk of kidney disease, metabolic disorders and high blood pressure for the child later in life.”

“Obesity increases the risk for preeclampsia by at least twofold,” said Dr. Lucia Larson, Director of Obstetric Medicine at the Women’s Medicine Collaborative. Through preconception counseling, health professionals can work with at-risk women on lifestyle modification to minimize weight gain, which can also “set them up for a healthier pregnancy the next time around.”

Doctors and community health centers could help identify at-risk women before conception by tracking what Dr. Kathleen Hill, maternal health team lead for USAID’s flagship Maternal Child Survival Program, called the “fifth vital sign”: asking every female patient if she wants to be pregnant within the next year.

“For most women in low- and middle-income settings, pregnancy and childbirth might be the only touchpoints they have with the formal health system,” said Dr. Hill, making pregnancy “an incredibly important opportunity to capitalize on” in the battle against non-communicable diseases like hypertension. In low-resource settings, many women only receive one antenatal care visit, even though the World Health Organization now recommends at least eight contacts. She advocated for group antenatal care as an effective way of increasing uptake.