Using tools to reduce hypertensive disorders in pregnancy
Hypertensive disorders of pregnancy — chronic hypertension, gestational hypertension, preeclampsia and eclampsia — are a major cause of maternal mortality and can lead to problems for both mother and baby.
A trend toward underdiagnosis, along with the latest tools to diagnose and treat high blood pressure during pregnancy, will be explored at the Saturday session “Bridging the Gap: Leveraging Innovation to Address Unmet Needs in Cardiovascular Care.”
Joyce Njoroge, MD, clinical assistant professor of medicine in the division of cardiovascular medicine at Stanford University, said 15.9% of all deliveries in the United States are complicated by hypertensive disorders of pregnancy (HDP), which also account for about 7% to 10% of pregnancy-related deaths.
“Undiagnosed and untreated HDP is one of the driving factors for our abysmal maternal morbidity and mortality rates in the United States. The risks are not only maternal, but also fetal, and have long-term impacts on the potential development of future cardiovascular disease,” Njoroge said.
“Often, there is an inappropriate leniency in allowing high blood pressure during pregnancy that is assumed to be transient, without appropriate follow-up and monitoring,” she said. “Normal physiology during pregnancy causes lower blood pressure, so even in the face of stress or other triggers, high blood pressure readings should be closely monitored, and the threshold to treat should be lower, particularly in higher-risk mothers.”
Current HDP assessment relies predominantly on clinic-based evaluation, Njoroge said, with limited adoption of home monitoring. But newer tools can help prevent maternal deaths, she said. The tools include mobile or at-home blood pressure monitoring programs that aren’t standardized but can be applied per institution preference and resource availability.
Njoroge said there is no benefit to applying the tools that way, it is just the reality that new guidelines and recommendations are slow to be adopted — particularly when there are added resource requirements from either the institution or the patient.
“In the ideal world, this would be standardized practice with automatic applicability in all of the different medical systems,” she said. “For example, at this time not all hospitals or clinics are electronic, not all use the same electronic medical records, and not all have the same workflow for communicating with patients. Each of these factors impacts the ability to use home-based monitoring systems in a standardized way.”
Njoroge plans to discuss Babyscripts myJourney, a free pregnancy and postpartum app that has been endorsed by the American College of Gynecologists, the Centers for Disease Control and Prevention and the National Institutes of Health. The app offers users monitoring to detect elevated risks between prenatal and postpartum appointments as well as dedicated care managers who can support patients enrolled in high-risk remote monitoring programs. Babyscripts is available from both the Apple App and Google Play stores.
In addition to those tools, Njoroge said telemedicine is playing an increasingly vital role in care during pregnancy. “These (telemedicine) visits can help bridge the gap and see patients in more convenient settings when there are obstacles to receiving appropriate care,” she said.
Another important tool for clinicians is the American Heart Association’s 2025 Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults. Njoroge said the guideline expands on care during pregnancy and highlights how critically important managing high blood pressure during pregnancy is.
The new guideline covers the various definitions of hypertensive disorders of pregnancy and specifies distinct thresholds for starting therapies. “This is an important growth point as we see hypertensive disorders of pregnancy contributing to our maternal morbidity and mortality epidemic,” Njoroge said.
The session Saturday, presented jointly by the American Heart Association and the Association of Black Cardiologists, will feature discussions addressing how to meet unmet needs in cardiovascular care with advancements in digital health, personalized prevention, diagnostics powered by artificial intelligence, and community-based interventions.
