COMMENTARY

Preeclampsia: Preventing Maternal Cardiovascular Events

JoAnn E. Manson, MD, DrPH

Disclosures

April 25, 2018

Hello. This is Dr JoAnn Manson, professor of medicine at Harvard Medical School and Brigham and Women's Hospital in Boston, Massachusetts. I'd like to talk with you about a recent report in Obstetrics & Gynecology[1] on time trends in the use of antihypertensive medications during labor and delivery, hospitalizations among women with preeclampsia, and corresponding time trends in the rate of maternal stroke.

This study used a national electronic database in which there were about 240,000 women with preeclampsia who were hospitalized for labor and delivery. This represented about 15% of hospitalizations during the time period 2006-2015.

Preeclampsia is a major cause of maternal and neonatal morbidity and complications. It's linked to about a doubling of the risk for maternal stroke, especially when the systolic blood pressure is 160 mm Hg or higher.

In this study, the investigators documented that there had been a substantial increase in the use of antihypertensive medications. In 2006, about 38% of women with preeclampsia were being treated with antihypertensives, and in 2015 it was 49%, a nearly 30% increase in the use of antihypertensive medications. The most common medications used were oral or intravenous labetalol, hydralazine, and nifedipine. During the same time period, there was a substantial reduction in the rate of maternal stroke. Overall, the rate decreased nearly 50%, from 6.6 to 3.5 cases per 10,000 deliveries; and among women with severe preeclampsia, there was a reduction from 13.5 to 6 cases per 10,000 deliveries.

Overall, this is very good news that there has been improvement in the treatment of hypertension among women with preeclampsia, and also a corresponding reduction in the rate of maternal stroke. It's likely that much of the credit goes to the American College of Obstetricians and Gynecologists for their very clear guidelines about the management of blood pressure among women with preeclampsia.

But there's still room for improvement, especially with other stakeholders, including regulatory agencies, insurers, other professional societies, and state quality care collaboratives. More progress could be made, but it's very gratifying to see increased attention to this very important issue.

Thank you so much for listening. This is Dr JoAnn Manson.

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