Early Identification, Clinical Intervention, and Patient Education Expands Preeclampsia Awareness

Photo Credit: Henadzi Pechan

The reasons why preeclampsia and other hypertensive disorders impact up to 8% of pregnancies are not fully understood, prompting calls for further research.

According to the Preeclampsia Foundation, the precise reasons why preeclampsia, which typically occurs after 20 weeks of pregnancy, and other hypertensive disorders impact an estimated 5% to 8% of pregnancies are not fully understood, and ongoing research efforts seek to gain greater insight into etiologies of preeclampsia and measures to improve clinical outcomes.¹ The Preeclampsia Foundation and the American College of Obstetricians and Gynecologists (ACOG) note that clinicians currently rely on the medical and pregnancy history to assess a patient’s risk, and the only available preventive measure is the use of low-dose aspirin in high-risk patients to postpone or thwart the incidence of preeclampsia.^1,2

The American College of Obstetricians and Gynecologists categorizes risk factors as high or moderate.^2,3 The ACOG indicates that factors categorized as high risk for preeclampsia include chronic hypertension, pregestational diabetes, history of preeclampsia, multifetal gestation, having an autoimmune disease, and kidney disease.^2-4 While moderate risk factors include nulliparity, advanced maternal age (defined as ≥35 years), obesity, interpregnancy interval of more than or equal to 10 years, family history of preeclampsia, certain sociodemographic characteristics (including lower socioeconomic status or lack of access to care) and in vitro fertilization (IVF).^2-4

The Preeclampsia Foundation indicates that preeclampsia rates continue to increase in the U.S. and represent one of the primary causes of maternal and infant illness and mortality.¹ The organization also notes that 60% of preeclampsia-related mortality is preventable.¹ Therefore, there is an ongoing need to expand awareness about preeclampsia and preventative measures.¹

According to a recent publication in JAMA, researchers aimed to assess preeclampsia risk factors by conducting a retrospective analysis of US live births from 2010 to 2021, focusing on pregnancies between 24 and 42 weeks gestation with early prenatal care and complete birth certificates.⁴ Results revealed that there were significant increases in chronic hypertension (1.2% to 2.7%), pregestational diabetes (0.7% to 1.1%), obesity (22.5% to 30.5%), advanced parental age (14.7% to 20.1%), IVF rates (0.5% to 1.5%), and interpregnancy intervals (5.6% to 6.3%) among preeclampsia risk factors.⁴ Meanwhile, multifetal gestation (1.7% to 1.2%) and nulliparity (42.8% to 40.0%) decreased, and hypertensive disorders of pregnancy doubled (4.4% to 9.4%).⁴ Based on their findings, the authors concluded, “Public health efforts to reduce modifiable risk factors of preeclampsia, such as chronic hypertension, pregestational diabetes, and obesity, should be emphasized.” ⁴

In another recent publication in Implementation Science Communications, researchers sought to understand the barriers and facilitators in employing a patient safety bundle for managing pregnancy-related severe hypertension, including preeclampsia, in three North Carolina outpatient clinics.⁵ Identified barriers included insufficient provider-patient interaction time, transportation challenges, and limited care protocols, while key facilitators included staff acknowledgment of treating preeclampsia, the availability of prompt treatment, enabling systems for identifying at-risk patients, and training staff on accurate blood pressure measurement.⁵ The authors concluded that community-engaged approaches are key to effectively addressing and managing preeclampsia.⁵

Clinician Perspectives

A physician practicing in an urgent care setting stated, “It is critical to screen patients early on and to routinely screen at every visit to make sure that mother and baby are doing well. In my years of practice, I have come across women who never monitored their blood pressure before or during their pregnancy, and some just attributed other symptoms associated with preeclampsia with being pregnant and did not mention symptoms until they started to affect their quality of life. The key to prevention is expanding patient education on the risk factors and common signs and symptoms and encouraging patients to seek care promptly. It is also important that healthcare providers engage patients in conversation to assess patient risk factors and determine if the patient is experiencing any symptoms. Encouraging patients to take a proactive role in care is critical.”

A pharmacist practicing in a community setting stated, “I often encounter women seeking guidance on the safe and proper use of OTC drugs during their pregnancy, and that could serve as an opportunity to educate patients about preeclampsia and encourage patients to discuss their risk factors with their OB/GYN, including monitoring of blood pressure and other related symptoms. Educating women about risk factors is critical as well. Measures such as community outreach programs, telehealth services, and patient education programs can be instrumental in expanding awareness about preeclampsia and the value of routine monitoring throughout pregnancy to ensure the health of the mother and baby. I think it is also essential to direct patients to reputable and reliable resources to obtain information.”    

Conclusion

Patient education and increasing awareness about preeclampsia, risk factors, signs, and symptoms such as (severe headache, swelling in the hands and face, visual issues, nausea and vomiting, stomach or abdomen pain, and/or shortness of breath) and the importance of routine healthcare are critical tools that can be employed to preventing and decreasing the incidence of preeclampsia and improve clinical outcomes for the health and well-being of the mother and their babies. The Preeclampsia Foundation has a wealth of patient education resources that healthcare providers can employ to expand awareness about preeclampsia.